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2. Frederick Speed Management Information Sheet
   Thank you for your interest in the Town of Frederick Speed Management Program (FSMP). Please complete the form below to register in the program. All program registrants will receive education and enforcement in their neighborhood. Registrants interested in engineered traffic calming measures (speed humps, traffic circles, etc.) must also submit the FSMP Petition Form with signatures from 20 neighbors (1 adult per household) or 30% of the households on the same block. FSMP Registration Forms may be emailed or submitted in hard copy to: Town of Frederick Engineering Department, 323 5th Street, Frederick, CO 50530. If you have any questions about this form or the FSMP, contact Jason Berg at 720-382-5601 or jberg@frederickco.gov.
4. Name:*
6. Address:*
8. City:*
9. State:*
10. Zip Code:*
12. Phone:*
13. Email:*
15. Location and Issue Information
    In the space provided below, fill in the street name and cross streets (the streets that the block is in between). Then, describe the issue you would like addressed by the Town of Frederick.
17. Street Name (Where Traffic Calming is Desired):*
19. First Cross Street:*
20. Second Cross Street:*
22. Please Describe the Issue or Concern on Your Street:*
24. Does the Area of Your Speeding Concern Have the Following? (Select All the Apply)

    1. Bicycle Facilities (Buffered or Protected Lanes, Multiuse Paths, Standard Lanes, Routes)
    2. Pedestrian Facilities (Sidewalks, Multiuse Paths)
    3. Schools
    4. Park or Recreation Center
    5. Library
25. Education: I am Interested in the Following. (Select All that Apply)

    1. Brochure
    2. Speed Radar Trailer
    3. Neighborhood Yard Sign
29. Enforcement:

    All Applications Will Be Placed on the Speed Radar Trailer/JAMAR Deployment List

30. Petition Submittal

    Please submit your neighborhood's petition to enroll in the engineering component of the FSMP. If you are interested in a physical traffic calming device on your street (like a speed hump) you must have a complete petition. The petition form can be found here. You may email this form to Jason Berg or mail it to the Town of Frederick: 323 Fifth Street, Frederick, CO 80530 or present it in person to the Front Desk at the same address.

32. Thank You for Your Interest in the Frederick Speed Management Program!
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field