Request Distracted Driving Avoidance Program

First Name *

Last Name *

Email Address *

Date of Birth (YYYY-MM-DD) *

Phone Number

Citation #

Mailing Address *

City *

State *

Zip Code *

I have read the Distracted Driving Avoidance Program conditions. *

Agree

I have read the Distracted Driving Avoidance Program eligibility requirements. *

Agree

I choose to enter a plea of NO CONTEST to the violation on the citation listed above. *

Agree, I'm entering a plea of No Contest

I understand that a conviction will be reported to Oregon Department of Motor Vehicles. *

Agree, I'm entering a plea of No Contest

I am requesting to sign up for the Distracted Driver Avoidance Program *

Agree

Additional Comments to Court Staff

Thank you for submitting your request for the Distracted Driving Avoidance Program! Requests are typically reviewed within 2-3 business days and you will be contacted by court staff.

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