District 10 Public Involvement Comment Form

Feedback
Required fields are marked with an asterisk.(*)

Please select the project you are interested in providing feedback for.

In what municipality do you live?

In what municipality do you work?

What interest do you represent?

Resident
Property Owner
Public Official
Community Facility
Business Owner
Community Organization
Other (Please Explain)

If Other, Please Explain

What concerns do you have about the project?

What would you like the project team to consider as part of this project?

Additional Comments

Contact Information

If you would like a PennDOT representative to contact you regarding your comments, please provide your information below.

First Name

Last Name

Phone Number (XXX-XXX-XXXX)

Email Address

Address

City

State

Zip Code

Voluntary Information Survey (Optional)

As a recipient of federal funds, PennDOT strives to involve all groups relevant to its projects in its public involvement activities. The following information will assist PennDOT in planning outreach to communities during the course of the project. Thank you for your participation.

Zip Code

County

Gender

Race

Disability

NoYes

Household Income

Second Language

First Language

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Pennsylvania Department of Transportation

PennDOT

Pennsylvania Department of Transportation

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