Violation- Distracted Driving Education Program Form

Please fill out the form below if you wish to participate in the Distracted Driving Education Program. We will respond to your request once we have received the citation from Hermiston Police Department.

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FIRST NAME *

LAST NAME *

DATE OF BIRTH

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MAILING ADDRESS *

CITY *

STATE *

ZIP CODE *

CITATION NUMBER (6 digits and starts with a "2") *

DATE OF OFFENSE *

EMAIL ADDRESS *

PHONE NUMBER *

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

Agree, I am entering a plea of No Contest.

I have read the Distracted Driving Education Program conditions. *

Agree

I have read the Distracted Driving Education Program eligibility requirements and am eligible. *

Agree

Additional Comments to Court Staff

Violation- Distracted Driving Education Program Form

Contact Information