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Portland Bureau of Transportation

We keep Portland moving

Phone: 503-823-5185

Fax: 503-823-7576

1120 SW Fifth Ave, Suite 800, Portland, OR 97204

More Contact Info

Curb Ramp Request Form

Location

Intersection of proposed curb ramp:
Street name
Cross street(s)

Corners Needing Ramps

Check the corners of the intersection lacking curb ramps:
NW corner
SW corner
NE corner
SE corner

I Need Access For:

Wheelchair or other mobility device, per the Americans with Disabilities Act (ADA)
Other, please describe below:
(e.g. child stroller)

This Will Provide Me Access To:

My Home
My Work
Public Transit
Public Accommodations
Other, please describe below:
(e.g. commercial area)

Enhancing Traffic Safety

Is the location at an intersection with:
a traffic light
a marked crosswalk
marked school crossing
a stop sign

Provide Access to Public Transit

How close is the proposed ramp site to a bus stop or light rail station?
within one-block radius
between 2-3 block radius
more than 3 block radius

Provide Access to Public Accommodations

How close is the proposed ramp site to stores, schools, recreational facilities, medical offices or other public accommodations?
within one-block radius
between 2-3 block radius
more than 3 block radius

Creates Connected System of Accessible Pathways

Does the location complete a partially accessible intersection and/or expand an existing pathway?
Other specific information or comments:

Application Information

Name
Address
City
State
Zipcode
Phone Number
Email Address
* Required Field

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