Transportation Improvement Request Form

_____

If there is a concern with the state of a road, bridge, MoDOT maintenance, or other MoDOT concern please use the following form to alert your Green Hills Region Transportation Advisory Committee (TAC)

Question Title

1. Do you have a MoDOT concern?

Yes

Question Title

2. In which county is the concern located?

Caldwell

Carroll

Chariton

Daviess

Grundy

Harrison

Linn

Livingston

Mercer

Putnam

Sullivan

Question Title

3. Type of concern

Roadway

Bridge

Sidewalk

Maintenance

Multimodal

Other (please specify)

Question Title

4. Please provide specific information about your concern. Be sure to include the location and a general description of the problem.

Question Title

5. If this is a road, bridge, or sidewalk, how often do you use in a week?

0-2 times per week

3-5 times per week

6-10 times per week

10+ times per week

Question Title

6. On a scale of 1 to 10 with 10 being the worst condition, what would you rate your concern?

Clear

i We adjusted the number you entered based on the slider’s scale.

Transportation Improvement Request Form

_____

Question Title

* 1. Do you have a MoDOT concern?

Question Title

* 2. In which county is the concern located?

Question Title

* 3. Type of concern

Question Title

* 4. Please provide specific information about your concern. Be sure to include the location and a general description of the problem.

Question Title

* 5. If this is a road, bridge, or sidewalk, how often do you use in a week?

Question Title

* 6. On a scale of 1 to 10 with 10 being the worst condition, what would you rate your concern?

1. Do you have a MoDOT concern?

2. In which county is the concern located?

3. Type of concern

4. Please provide specific information about your concern. Be sure to include the location and a general description of the problem.

5. If this is a road, bridge, or sidewalk, how often do you use in a week?

6. On a scale of 1 to 10 with 10 being the worst condition, what would you rate your concern?