Neighborhood Traffic Management Program

Community Action Request Form

Part I

Both Part I and Part II must be completed before submitting to the Department of Transportation.

Please indicate traffic issues that concern residents in your neighborhood.

If you selected "other", please explain:
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Please describe the boundaries of your neighborhood:
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Are you aware of any neighborhood associations that represent your area?
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The petition below must be completed prior to submitting the CAR form. Each of the 10 residents signing this petition must be at least 18 years of age from separate households within the neighborhood boundaries described.

By signing, the residents below are requesting that this neighborhood be included in the Neighborhood Traffic Management Program.

	Signature	Printed Name	Address	Phone Number
				(Optional)
1.	____________________	_____________________	______________________	__________
2.	____________________	_____________________	______________________	__________
3.	____________________	_____________________	______________________	__________
4.	____________________	_____________________	______________________	__________
5.	____________________	_____________________	______________________	__________
6.	____________________	_____________________	______________________	__________
7.	____________________	_____________________	______________________	__________
8.	____________________	_____________________	______________________	__________
9.	____________________	_____________________	______________________	__________
10.	____________________	_____________________	______________________	__________