| (*) = Required information. You MUST completely fill out this form, incomplete forms will not be accepted. This form must be completed and sent to Sgt. LeGarde (via the "Submit" button) at least 7 days prior to the date you wish to ride. See the following link to the ride-along agreement form you will be required to sign. Ride-Along Form |
| 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) |
| |
|
|
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