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Ride-Along Request Form

(*) = Required information. You MUST completely fill out this form, incomplete forms will not be accepted. This form must be completed and sent to either Sgt. LeGarde or Sgt. Huls (via the "Submit" button) at least 7 days prior to the date you wish to ride.

Your Information - Person requesting services.

* Full Name :

* Date of Birth :

(MM/DD/YYYY)

* Phone :

(xxx-xxx-xxxx)

* Email:

*University Student or Staff :

If yes *Student ID#

*Have you ever been convicted of a crime other than driving offenses?

* If you answered "Yes" to the above question, what was the conviction for and date it occured?

* Reason for ride along.

* Ride alongs are provided in blocks, please indicate the date and time you would like to ride.

(MM/DD/YYYY)