Request Distracted Driving Avoidance Program Form

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URL

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Name*

First Last

Email*

Date of Birth*

Phone

Citation #

Address*

Street Address Address Line 2 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*