Form Center

Welcome to the City of Rockville Form Center. If your form requires a response, we will contact you as soon as possible.

Search Forms:

Search Forms Select a Category

All Categories
City Clerk
City Manager
Claims
Code Enforcement

Community Planning and Development Services
Finance
Housing Programs and Services
Human Resources
I-Rock

Police
Public Works
Recreation and Parks
Report a Concern
Volunteering

By 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

Report Multiple Streetlight Outage or Problem

This form has been modified since it was saved. Please review all fields before submitting.

Thank you for notifying the city about a streetlight issue. We try to respond to reports within five business days.
Streetlight Information
Pole 1
Pole number, if known.
Use the city's interactive map to help located the streetlight number.
Location/Address
Additional location description (e.g., nearby intersection or landmark)
Condition of light:
1. Light out
2. Cycling on/off
3. Lit constantly
4. Lens missing, hanging, or broken
1. Light dim
2. Fixture damaged
3. Pole broken, damaged, or leaning
4. Other
Pole 2
Pole number, if known.
Use the city's interactive map to help located the streetlight number.
Location/Address
Additional location description (e.g., nearby intersection or landmark)
Condition of light
1. Light out
2. Cycling on/off
3. Lit constantly
4. Lens missing, hanging or broken
1. Light dim
2. Fixture damaged
3. Pole broken, damaged or leaning
4. Other
Pole 3
Pole number, if known.
Use the city's interactive map to help located the streetlight number.
Location/Address
Additional location description (e.g., nearby intersection or landmark)
Condition of light
1. Light out
2. Cycling on/off
3. Lit constantly
4. Lens missing, hanging or broken
1. Light dim
2. Fixture damaged
3. Pole broken, damaged or leaning
4. Other
Reporter
Information will not be shared. Leave blank if you wish to remain anonymous.
Do you wish to be notified about repair status?
The time it takes to complete repairs may depend on the severity of the issue.
1. Yes
2. No
First Name
Last Name
Phone
Email