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School Safety Assessment Request Form
Alameda County Safe Routes to Schools Program
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* Indicates required question
Name of School
*
Your answer
Address of School
*
Your answer
Name of Requesting Person
*
Your answer
Phone Number
*
Your answer
Please Check All that Apply to Your School
We have a Safe Routes to Schools leader (parent or staff) at our school
Parents have a strong concern about traffic safety
Parents have strong concerns about crime or other safety issues
We have a program to encourage walking and/or bicycling to school
Thank you for your commitment to providing safer, more walkable neighborhoods for children and families!
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