Name and Address of person writing the letter
[Name and Address of traffic engineer in charge of the intersection]
This letter is to request the installation of an Accessible Pedestrian Signal (APS) at the intersection [insert street names]. As a pedestrian who is [blind, visually impaired ] I am unable to use the visual pedestrian signals currently installed at this location and need access to the information in order to cross the street. As you may be aware, there is a bus stop at this intersection; I must cross the street daily to reach the bus stop. [change that last sentence to fit the specifics of the intersection, especially if there are some issues that make it particularly hard to cross such as poor traffic sounds, lots of right-turning traffic, t-intersection, etc.]
I would like to meet with you or someone from your department at the intersection in question to discuss appropriate modifications. I would also like for [insert name of ACVREP certified orientation and mobility specialist (COMS)], a certified orientation and mobility specialist at [insert agency name] to join us. You may contact me at [insert phone number, address or email] or [insert COMS instructor name] at [insert phone number or email] to set up an appointment. Thank you for your attention to this matter.
cc: [COMS specialist name, agency affiliation]