Skip to Main Content
Community & Recreation
About Rock Island
Select a Category
Boards & Commissions Application
City Clerk Forms
Freedom of Information Act Requests
Request Tracker Forms
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress
Handicapped Parking Space Request Form
This form has been modified since it was saved. Please review all fields before submitting.
The installation of a handicapped parking space does not restrict the handicapped parking space to only the person requesting the space but is accessible to anyone with a handicapped license plate or placard.
First Name of Handicapped Resident
Last Name of Handicapped Resident
Property Address 1
Property Address 2
Does the handicapped resident own the property?
If NO, please provide the name, address, and telephone number of the property owner:
Please describe the location to be designated as a handicapped parking space:
Does the handicapped resident have access to off-street parking such as a driveway or garage?
If YES, please describe the off-street parking and explain why the handicapped resident does not use the off-street parking:
In order to utilize a handicapped parking space, a motorist must have a handicapped license plate or placard.
List the handicapped license plate or placard number.
Please provide any additional information that may be of assistance to the Traffic Engineering Committee and the City Council members when they review your request:
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
Submit and Print
* indicates a required field
Slideshow Left Arrow
Slideshow Right Arrow