BPSE / SRTS Request Form
Bicycle & Pedestrian Safety Education (BPSE) Program
Safe Routes to School (SRTS) Program

Maine’s Bicycle and Pedestrian Safety Education (BPSE) program is an innovative partnership of the Bicycle Coalition of Maine and the Maine Department of Transportation. The program provides:
1) bike and pedestrian safety instruction to children and adults via presentations and experiential riding programs,
2) management of the Maine Safe Routes to School (SRTS) program to encourage students to bike and walk to school,
3) education and information to communities about program, policy, and infrastructure options to improve walking and biking conditions, and
4) education to all roadway users about how to safely, legally and courteously share the road.

Please complete the form below to request BPSE and/or SRTS program assistance.

Please use the "Other" field to ask specific questions about the program and a program representative will follow up with you. ***Note that our Helmet Program has been discontinued***

We depend on the availability of instructors in your area to provide you with programming and make every effort to fill all requests. PLEASE NOTE THAT NOT EVERY PRESENTATION REQUEST CAN BE COVERED.

General Info
Full Name
First Last
Your answer
Email
Your answer
Phone Number
Your answer
Position
E.g., Teacher, Nurse, Secretary
Your answer
Organization / School
Your answer
Street Address
Your answer
City
Your answer
Zipcode
Your answer
County
Educational Event Type
Select all that apply.
Required
Define the specific need for this request
E.g., Students have demonstrated unsafe walking / cycling practices, there has been an accident, dangerous infrastructure exists near the school. ***Be specific when possible to show why students NEED this safety training***
Your answer
Clarify how the requested activity will address the above need
Be specific when possible
Your answer
Estimated Number of Participants (total)
Due to the interactive nature of the presentations, we strongly recommend that groups of more than 45 should be broken into smaller units of similar age. If you are considering an assembly-type event, please provide details of your event in the "Additional Info" field below.
Your answer
Estimated Number of Presentations
Due to the interactive nature of the presentations, we recommend presenting to groups of similar age numbering no more than 45 per presentation (20-30 is optimal, like a class or a scout troop etc.). Please estimate the number of groups/classrooms of that size needing a presentation. If you are considering an assembly-type event, please provide details of your event in the "Additional Info" field below.
Your answer
Age Groups or Grades
E.g., kindergarten, grades 4-6, adults, all ages
Your answer
What date(s) and time(s) are available for this event?
Please provide info on when you need program assistance. Be as specific as you can. Note that large groups (eg entire schools) may need multiple visits by program representatives. FINAL SCHEDULING IS DEPENDENT ON INSTRUCTOR AVAILABILITY, but we will make every effort to accommodate your preferred date/time.
Your answer
Have you hosted a BPSE instructor in the past?
Select Yes or No. If yes (and if you remember!) include the instructor's name in the "other" field.
Additional Information
Any other info you want to include or questions you need to ask. If you're thinking of an assembly or other atypical event, please provide details here.
Your answer
Safe Routes to School (SRTS) Encouragement & Planning Program
The SRTS Program offers 3 levels of technical assistance to help communities host encouragement & incentive activities to get more students walking and biking, work on safety enforcement, explore the Maine Walking School Bus Program, and/or do evaluation of local barriers to safe walking and bicycling and plan for improvements. For more information on Safe Routes to School and its services, visit http://www.bikemaine.org/education-safety/youth-education

Would like to receive the Maine Safe Routes to School monthly e-Newsletter?
--- Visit the following weblink to signup: http://goo.gl/hwWXZM
--- Or to view archived newsletters: http://www.bikemaine.org/maine-safe-routes-to-school-newsletter-archive

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