Lane County Safe Routes to School Request Form
Using this form, you can request programming, materials and other services related to Safe Routes to School. If you do not see what you need on this form, please describe your request in the "Other" section at the end, or contact Megan Shull, Safe Routes to School Coordinator, directly at mshull@lcog.org or 541.682.4023.
Contact for this Request
School or District
*
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Affiliation with the School
Parent/guardian, teacher, community member, etc.
I am requesting support with:
Check all that apply.
*
Walk & Roll Events
Pedestrian Safety Education
Bicycle Safety Education
Scooter Safety Education
Arrival/Dismissal observation
Walking School Bus - a chaperoned group that walks together on a regular basis.
Materials for parents or student education
Encouragement & Engagement events - for students and the greater community
Organize remote drop-off/pick-up location to relieve parking lot congestion
Book lending library - selected books that feature active transportation and community. Borrow for your classroom or library.
General Safe Routes to School information and how to get started
Other
If you selected "Other", please describe your request below:
Additional comments or concerns:
Submit
Should be Empty: