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AVR Online Survey Collection

Please complete the following form.


If you have questions about this survey or you are not an employee of College Hospital Cerritos please email Marites Leija at or call (562) 924‑9581xEXT383 for assistance.

Step 1: Name
Step 2: Home Address - Address is confidential and will not appear on anyone else's RideGuide. *
Step 3: Contact Information

Step 4: Work Hours and Commute Information
Step 5: Survey Week Commute Information

Instructions: Please select a time and commute mode for each day that appears below. You should fill out the time you began work.

If you were on vacation, out sick or had a regular day off during the survey week, please provide your normal scheduled time for that day.

In the blue section below, the most common misinterpreted codes are defined.

Commute Modes Explained

Monday 9/12/2022

Tuesday 9/13/2022

Wednesday 9/14/2022

Thursday 9/15/2022

Friday 9/16/2022

Saturday 9/17/2022

Sunday 9/18/2022

Step 6: Commuter Information

*Per California Penal Code section 637.6 this information will be used for carpooling or ridesharing purposes. I understand that my signature allows the information provided to be used for ridesharing purposes in the regional ridematching database sponsored by Los Angeles County Metropolitan Transportation Authority (Metro), Orange County Transportation Authority (OCTA), and Ventura County Transportation Commission (VCTC) and through joint partnerships with local cities and Transportation Management Associations to promote ridesharing programs and reduce congestion. I understand these entities are strictly prohibited from disclosing this information to any other third parties.

I acknowledge that my participation in ridematching is voluntary and that I am responsible for my participation in a rideshare arrangement. I understand that the sponsoring agencies shall have no responsibility or liability for any claims, expenses or damages resulting from any individual's participation.