Safe City Inquiry Form

If you are interested implementing a Safe City Program, a good start is to complete a self assessment of your community.  The form below allows you to assess the current state of your community through crime stats, existing partnerships and current resources available, which in turn will help determine the viability of a Safe City project in your community. 

After completing and submitting the form, someone from the Safe City team may contact you.

Community Contact Information

Name:				Phone:
Address:				Fax:
City:				Website:
State / Zip:				Organization:	- Select -Law EnforcementBusinessCity LeaderCommunity GroupOther

I am interested in implementing a Safe City
I am interested in becoming a Corporate partner

Community Characteristics
Population (city and greater area):
Approximate # of business entities able to participate in a Safe City project?

Key Contact Information

Contact Name:				Phone:
Contact Address:				Fax:
Tite:				Email:

Community Characteristics
What are some specific crime and safety issues your community struggles with most?


Community Partnership Experience
Past participation in local partnerships focused on safety is not a requirement for being considered as a possible Safe City location.
However, we would like to know about any experience you may have with collaborative initiatives in your area.

Have you in the past or are you currently engaged in any public / private initiatives in an effort to drive community safety?
Yes No

If so:

What was the main focus of the safety initiative?
Who were the active community partners?
What programs/initiatives/actions were implemented?
How long did the efforts last?
Were these efforts successful?

Why / How Safe City?
How do you think the Safe City program can help your community address it's most serious and
persistent safety issues?


Safe City Partners
Have other organizations expressed their willingness to participate in a community safety program
such as Safe City?
Yes No

If so:

Which organizations?
Do they have specific resources to contribute?

Safe City Resources
Does your community and/or organization have resources available to invest in the Safe City program?
Yes No

If so:

What types of resources are available? (Financial, staff, expertise, technology, etc.)

If not:

What specific needs would be required for your community to have a successful Safe City? (Financial, staff, expertise, technology, etc.)