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2. Event Information
   Please describe in detail the event being held
4. Name of Event*
5. Date/Time of Event*
   Date/Time of Event

   Date/Time of Event
6. End Time of Event*
   End Time of Event
8. Address of Event*
9. City
11. States
    -- Select One --ALAKASAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMHMAMIFMMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVAVIWAWVWIWY
12. Zip Code
14. Event Description
    Ideally requests made to the Durham Police Community Services Division should be made 30 days prior to the event.
16. Anticipated Number of Participants:*
17. Units:

    1. Community Resource Unit (CRU)
    2. Crisis Intervention Training (CIT)
    3. Community Engagement Unit (CEU)
    4. School Resource Unit (SRO)
    5. Hispanic Liaison Officer
    6. LGBTQ Liaison Officer
    7. Victim Services Unit
    8. Color/Honor Guard
    9. Citizen Observer Patrol (COP)
    10. Police Athletic League (PAL)
    11. DPD University
    12. Other (please explain)
19. Contact Information
21. First Name
22. Last Name
24. Address
25. City
26. States
    -- Select One --ALAKASAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMHMAMIFMMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVAVIWAWVWIWY
28. Zip Code
29. Phone Number
30. Email Address
32. Agency Name:
33. Type of Agency/Group:

    1. Business
    2. Neighborhood
    3. Government
    4. Faith-based/Church
    5. Education/School
    6. Public Safety
    7. Other
35. Services Requested
    Services Requested: Describe in detail what you are requesting the unit(s) to do. Audience Demographics: Provide approximate size of audience(s), age ranges and other factors/information that will assist staff in preparing for the event. Description:
37. Description:
    Note: Before submitting electronically it is important that you print out and retain a copy of completed form for your records. Also, as a reminder, note that a submission is not a guarantee of acceptance. To verify receipt and check status of your request, call the Community Services Division at (919) 560-4438 extension 29224 or the DPD Public Affairs Office at 560-4322 extension 29194.
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field