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Crime Prevention Program Request

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Use this form to request one or more of the crime prevention programs/ presentations offered by the Christiansburg Police Department.

Please submit this request form at least two weeks in advance to allow ample time for the Christiansburg Police Department to prepare for your program request.

Contact Information

Name:*

Business or Organizational Affiliation (if applicable):

Telephone (Numbers only; Ex. 5403826128):*

E-Mail:*

Program Information

Please select the program(s) you are interested in.*

	Neighborhood Watch Meeting
	Fraud and Scams
	Residential Security Assessment
	Personal Safety
	Internet Safety
	Identity Theft
	Robbery Prevention

	Business Watch
	Business Security Assessment
	Bring a Police Car to an Event
	Fingerprinting Kids
	Police Department Tour
	Talk on Programs Offered by the Police Department
	Other

If Other, Please List Program Requested:

Preferred Date of Presentation:*

Secondary Date (if primary date is not available):

Time of Program (Please Indicate AM/PM):*

Location of Program:*

Approximate Number of Attendees:*

Approximate Age Range of Attendees:*

Please provide additional information pertinent to the event, such as whether it is a special public event or regular meeting, time limit for presentation, etc.

* indicates required fields.

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100 East Main Street
Christiansburg, VA 24073

Ph: (540) 382-6128
M-F Hours: 8:00 am-5:00 pm

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