海角社区 | Police Department | Community Education Request Form

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    • Community Education Request Form

    Contact Information

    *First Name:
     
    Middle Initial:

    *    Last Name:
     
    *Organization Name:
     
    *Phone Number:
     
    *Email:
     


    Presentation(s) requested

    *Requested Program Topic(s):

    If you selected other, please describe the type of programming you are interested in:

    *Date requested:

    *Time requested:

    *Length of presentation (i.e. 1 hour)?
     
    *Location of presentation:

    *Approx. # of attendees:
     

    Additional Comments:

    Security Password (Please type the word ):



    If you have questions or concerns you can contact the police department at 815-836-5222 or lewispolice@lewisu.edu. Invisible line, width of the page