Crime Prevention Program Request Form

* Required

Name of Department/Organization*

Type of Event

Specific Topic*

Contact Person*

WFU ID Number (if applicable)

Status (check one)

E-mail Address*

Phone Number

Date of Event*

**Location of Event*

Beginning Time*

Ending Time*

Anticipated Number of Participants*

**Location must be reserved through proper channels and paid for by requestor. Please confirm location reservations prior to submitting this request.

This form is a request only. Date of program is not final until you have received confirmation from the University Police Department. For further information, please call 758-3567

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