Community Engagement Request Form

Name * Required
First Last
Email * Required
Phone * Required
Event Date * Required
MM slash DD slash YYYY
Event Time * Required

: Hours

Minutes

AM/PM AM/PM
Event Location/Address * Required
Street Address Address Line 2 City State ZIP Code
What type of Community Engagement activity are you interested in? (IE; Formal Safety presentation, Social- Greet and Meet, Classroom Visit, Swag/Safety Resources Booth, etc.)
Who will be at the event? How many participants?
Is any specialized equipment requested at the event? (IE, patrol vehicles, canine, SWAT, command center, etc.)
Are there specific safety topics you want addressed? (IE, Scam- Fraud, Senior Safety, Restorative Justice, Internet cyber-bullying Prevention, Drug Awareness and prevention etc.)
Are there any additional instructions our staff needs to know to make this a successful engagement opportunity?
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