Request a Crime Prevention Program

UW-Stout Police

Please submit ten days prior to presentation date

Date of request:

mm/dd/yy

Date of event:

First Preference:

Second preference:

Organization name:

Program requested:

Name of building:

Location of event:

Number of attendees:

Special Equipment Required?:

Yes

If yes, what type of equipment?:

Please fill out the above form and submit, or print the attached form and forward to your Liaison Officer