Form Center

2. This form is for scheduling a Community Engagement Session with a Police Officer, designed for both children and adults. The goal is to foster positive relationships and create a more accessible and comfortable environment between the community and law enforcement.

   Engagement options include, but are not limited to:

   • Requesting a police officer to serve as a speaker at community events.
   • Providing an interactive demonstration of police vehicles and equipment.
   • Distributing educational and informational materials related to safety and police work.
4. First Name*
5. Last Name*
7. Phone Number*
8. Email*
10. Location of Event

    Example: Name of Facility

12. Address1
14. Address2
16. City
17. State
18. Zip
20. Date and Time of Event*
    Date and Time of Event

    Date and Time of Event

    Please provide the date and time of the event.

21. Is this Date and Time flexible?*

    1. Yes
    2. No

    If there is flexibility with the stated date and time please let us know.

23. What is the target audience ages?*

    1. Pre K - Kindergarten
    2. 1st - 4th Grade
    3. 5th - 8th Grade

    1. 9th - 12th Grade
    2. College
    3. Adults

    Select as many as needed for mixed audiences.  

24. Please specify the desired topic or activity for this session.*
26. Comments/Questions
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field