PEWTW E-Bike Eligibility Form

Portland Electric Ways to Work E-Bike Eligibility Form

Thanks for your interest in the Portland Electric Ways to Work program! Please complete all questions to determine eligibility in the program. This program can support you in either purchasing or getting a loan for an electric bike. If you are eligible for the program, MFS will provide a $500 incentive towards the cost of an e-bike. In addition, we also have limited funding for participants to purchase up to $250 in safety gear (helmet and lock). We will be in contact with you for next steps.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please select your age range:*

0-1516-17 (you must be 16 or older to ride an e-bike)18-2425-4445-6465+
How did you hear about this program?*
How did you hear about this program?*

Community partner/caseworkerCommunity eventFriend/familyOnline searchOther (please describe)
If community partner, please select which partner:

SEILatNetIRCONAYAHome ForwardPGEPacific PowerForthOther
If community event, please share which event:
What are you interested in?*

Purchasing an e-bike upfrontFinancing/getting a loan for an e-bikeI'm not sure, would like to learn about the optionsPurchasing a vehicle
Please complete this eligibility form for the auto program.
What is your current monthly income? (Ways to Work participants must have a household income less than 80% of Portland median family income.)*
How many people are in your household?*
Do you live within Portland city limits? (We are only able to serve Portland residents at this time)*

YesNoOther
Do you currently have stable housing?*

YesNo, please share more here:
The goal of the Ways to Work program is to help people build their credit and financial assets. To access the incentive for an electric bike, are you willing to attend one financial coaching session and participate in an interview about your experience in the program?*
The goal of the Ways to Work program is to help people build their credit and financial assets. To reach this goal and access the incentive for an electric bike, a central part of this program is financial coaching. Are you willing to participate in financial coaching to get ready for the loan and also while you have the loan? *
What is your current job?*
How long have you been at your current job? (Ways to Work participants must have at least 3 months at current job to participate in the program)*

0-3 monthsLonger than 3 months
If you have not been at your job for 3 months, how long were you at your previous job? And is there anything you would like us to know about your employment history?
How many hours do you work a week? If it varies each week, use the average hours per week. (Ways to Work participants must be working at least 20 hours a week to participate in the program)*

0-19 hours20 or more hours
Do you currently have any debt in collections? If so, please tell us about how much and a brief explanation of what is happening with it. *
Have you ever filed for bankruptcy? If so, what year and tell us what has changed since then. *
It is important to understand that this program takes time and not all loans can be approved quickly. Do you understand it may take anywhere from 1-3 months or longer before you can be approved for a loan? *
Are you willing to work on saving money while you get ready for your loan? *
Next are some questions about how you might use an e-bike. Note that answers to these questions will not affect your eligibility, but will help us tailor the program for you!
Why do you want to get an e-bike? *
What do you plan on using an e-bike for? Recreation, commuting, car replacement, etc. *
Do you have children you'd like to be able to take on an e-bike?*

Yes, one childYes, multiple childrenNo childrenNot currently, but would like the option
Currently what are your main modes of transportation? (Check all that apply)*

WalkingBikingPublic transportationGetting a ride from friends or familyDriving myselfSchool busOther
How many miles do you travel on a daily basis?*

0-5 miles6-10 miles11-20 miles21-40 miles41+ milesUnknownOther
Do you have a car?*

YesNo
If yes, what is your current car? (Make, model, year)
If you have a car, how often do you drive?

NeverA few times a yearA few times a monthA few times a weekDailyOther
How often do you currently ride a bike?*

NeverA few times a yearA few times a monthA few times a weekDailyOther
How confident do you feel riding a bike? *

1

2

3

4

5

1 is Not at all confident, 5 is Completely confident
Please expand on the confidence number you chose above. Would you like any support in learning how to ride a bike/e-bike?*
How comfortable or safe do you feel riding a bike in the part of town you live and plan to ride?*

1

2

3

4

5

1 is Very unsafe, 5 is Very safe
Please expand on the comfort and safety number you chose above. Do you have any safety considerations in regards to e-bikes?*
Have you ridden an e-bike before?*
Do you own a helmet?*

YesNoOther
E-bikes weigh more than traditional bikes and can be challenging to transport or carry up stairs. It's important to have a secure and accessible place to store your e-bike. Ground floor parking is the easiest and most convenient option.
Do you have a place in mind to park an e-bike? If you live in an apartment building without bike storage, do you have access to an elevator?*
This program is funded by the Portland Clean Energy Fund, which invests in climate solutions and climate actions, including electrifying transportation. How much do you think electric bikes help the environment or have a positive impact on the environment? *
What do you hope to see in your neighborhood in the future in terms of bikes/e-bikes, bike lanes and infrastructure, and e-bike parking?*
What is your race/ethnicity? (Check all that apply)*

AsianLatino/HispanicNative Hawaiian/Pacific IslanderBlackIndigenousSlavicMiddle EasternNorth AfricanWhiteDecline to answerPlease share your origin, ethnicity, ancestry, country of origin, race, and/or Tribal affiliations in whatever way you wish here:
What is your gender identity? (Check all that apply)*

ManWomanNonbinaryCisgenderTransgenderIntersexTwo SpiritDecline to answerOther
What is the primary language you speak at home?*

EnglishSpanishRussianCantoneseMandarinHmongKoreanVietnameseArabicOther (please list)
Thank you for completing this form. If you meet the eligibility criteria for the E-WTW program, we will contact you. If you would like us to know anything else, please share below.
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Portland Electric Ways to Work E-Bike Eligibility Form

Next are some questions about how you might use an e-bike. Note that answers to these questions will not affect your eligibility, but will help us tailor the program for you!