Neighborhood Safety Campaign Request Form
 Neighborhood Safety Campaign Request Form
* denotes a required field.
Today's Date:  09/07/10
Contact First Name:*  
Contact Last Name:*  
Address:*  
Address2:  
City:*  
State:  
Zip Code:*  
Message Phone:  
Day Phone:  
Email:  
Place on Mailing List?  
Select a location:(required)
 Neighborhood:
(If you don't see your neighborhood listed, please enter it here.)
OR
 Intersection: Primary Street:
Cross Street:
OR
 Street: Primary Street:
Cross Street1:
Cross Street2:
What concerns have you identified with the above location?*
Please provide contact names and phone numbers for the following:
  Neighborhood association:
  School PTA/PTC:
  Neighborhood Watch:
 Please check the items that you are requesting:(required)
Safety Campaign (Phase 1)
Lawn Signs Only
Radar Trailer Only

Note: The Safety Campaign includes radar equipment and lawn signs, however you may request lawn signs and/or the radar trailer only and not participate in the complete safety campaign as described in the newsletter. Please note that if you choose this option your street will not be eligible for further traffic consideration. (For example: speed bumps, traffic circles, curb extentions, etc.)

Questions?
Contact us at 503-846-7950 or 503-846-7900

Washington County
Land Use and Transportation Department
Traffic Engineering Section
1400 SW Walnut Street, MS 17B
Hillsboro, OR 97123-5625 		Phone: 503-846-7950
Fax: 503-846-7910

E-Mail to: luttraffic@co.washington.or.us

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