Quality of Life Form
Broadmoor residents are encouraged to use this form to submit Quality of Life issues. The BIA will work to advocate to the city on your behalf.
Address Number (of Issue) *
Street Name (of issue) *
City of New Orleans 311 Case # *
All reported issues must be recorded with 311 before the BIA is able to intervene. This helps BIA track issues through city enforcement agencies. The number should be in the form of (XXXXXX). If you did not record your assigned case number, please contact 311 and record your case number.
Issue Type *
Please select from the options below
Required
Please describe the issue(s) with as much detail as possible
Reporter's FIRST NAME *
Reporter's LAST NAME *
Reporter's DATE OF BIRTH *
Date of birth is only used for internal data collection and reporting.
MM
/
DD
/
YYYY
CONFIDENTIAL
Check this box if you have provided your name but request to remain anonymous (for any reason). The BIA does not disclose those who report issues in our neighborhood. Your name is only required so that we can report back to you about your issue.
Email address *
Please provide an email address so that we can contact you regarding your issue. If you do not have an email address please write n/a and provide a working contact number below.
Phone number *
Address Number (of reporter)
This is not required but is helpful to our organization. Your information will not be shared.
Street Name (of reporter)
Submit
Never submit passwords through Google Forms.
This form was created inside of Broadmoor Improvement Association. Report Abuse