Public Safety Program Request Form

Please complete the form below. Your form is only submitted when you have received a confirmation email.

Please complete this form at least two weeks before the preferred program date. Programs are 30 to 60 minutes in length unless otherwise specified by the Police Sergeant for Community Development and Crime Prevention, who will contact you to confirm your program after all information has been processed.

(Select only one of the following)
Building And Room #
Note: Room reservations are to be made by the person(s) requesting the program unless it is to be held in the ISUPD seminar room.