2. Ride Along Request Form

   
   

   Requirements:

   • Must be at least 18 years old
   • Must be currently enrolled in a Law Enforcement or Criminal Justice program 
   • Must clear a criminal history check
   • Must sign a liability waiver
4. First Name, M.I.
5. Last Name
6. Date of Birth
   Date of Birth
8. Permanent Mailing Address
9. Phone Number
11. City
12. State
13. Zip
15. Email Address
17. Name of College/University or Tech School
18. Currently Enrolled?
    -- Select One --YesNo

    *Must be currently enrolled to participate in a ride along

19. Anticipated Graduation Date
21. Dates Available for Ride Along
22. Preferred Shift

    1. Day Shift
    2. Afternoon Shift
    3. Overnight Shift

    Select all that apply

24. Is there anything else you would like us to know about you?
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field