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2. Welcome to our Resident Report form!

   We are dedicated to providing a safe and enjoyable community for all our residents. If you see a problem in your neighborhood, a local roadway, or a city property, you can submit this Resident Report form to bring it to our attention. 

   If a problem requires urgent attention, please call us immediately. For a police, fire, medical, or other emergency, dial 9-1-1. For less urgent matters, please contact (620) 626-0150. 

   Disclaimer: The information to be submitted on this form will be sent via email. To protect sensitive information, do not enter any personally identifying information into this form - including birthdate, social security information, bank accounts, health information, driver's license, etc.   

4. YOUR INFORMATION
6. Name:*
8. Phone Number:*
10. Address:*
12. Email:
14. SHARE YOUR CONCERN
16. Select the box that best describes your need:*

    1. Traffic Signals
    2. Traffic/Road Signs
    3. Pothole
    4. Damaged Curb
    5. Trash Pickup Service
    6. Storm Drain Problems
    7. Sewer Problems
    8. Water Condition Concern
    9. Street Lights
    10. Street Pavement Markings
    11. Sidewalk Concern
    12. Park Concern
    13. City Sports Field Concern
    14. Excessive Litter
    15. Building/Housing Code
    16. Fire Safety Concern
    17. Other Road Hazard
    18. Other (describe below)
18. Describe your problem or concern in more detail:*
20. Describe the location of your concern:*

    Please include addresses, street intersections, or other identifying information so we can locate your concern. List nearby amenities or landmarks, if able (example: sidewalk on the east side of Rosel Field at Blue Bonnet Park). 

22. Preferred Contact:*
    -- Select One --PhoneEmail

    How would you like us to contact you if we have additional questions about your request?

24. Thank you!

    Thank you for taking time to share your concern so we can address your need! We will submit your report to the appropriate department contact to address. 

Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field