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Requests must be submitted 10 days prior to the event.

Requester's Information

Today's Date:

Name:

Department:

Email:

Phone Number:

Event Information

Event Date:

Event Start Time:

Event End Time:

Event Name:

Event Location:

Event Type:

Individual in Charge of Event

Contact Phone Number:

Contact Email Address:

Police/Security Services Requested
(There will be a four hour minimum charge)

Number of Officers Requested:

Officer(s) Start Date:

Officer(s) Start Time:

Officer(s) End Date:

Officer(s) End Time:

Special Instructions:

Account Number to be Charged

Fund (6 digits)

Org (5 digits)

Acct (6 digits)

Program (2 digits)