Ride Along Request Form

You must live or work in the police division where you are requesting a ride along. Please determine which police division you live or work in before completing this form. Go to In Your Neighborhood for a list of divisions and neighborhoods.

Select your division from the following list: Central Division Eastern Division Midcity Division Northeastern Division Northern Division Northwestern Division Southeastern Division Southern Division Western Division

Name	Driver's License/ID
Date of Birth (mm/dd/yyyy)	Social Security Number

Home Address

City

Zip

Home Phone	Email Address
Occupation

Business Address

City

Zip

Business Phone

Desired Date of Ride Along

Is this your first ride along?  Yes   No

Desired Shift  1st Watch (0600-1600 hours)  2nd Watch (1600-0200 hours)  3rd Watch (2200-0800 hours)

Reason for Ride Along