NACOLE Peer Support Program Application

Name

First NameLast Name

Oversight Agency

Title

Address

CityState / Province

Country

Email

example@example.com

Phone Number

Area CodePhone Number

How long have you worked in the field of civilian oversight?

How long has your agency been in operation?

What model of oversight is your oversight agency?

If you chose "Hybrid" or "Other" please tell us more about the functions of your oversight agency.

What type of oversight does your agency focus on? (Please check all that apply)

Police/PatrolJailPrisonOther

Which of the following adjectives best describe you? (Please check all that apply)

What role would you like your PEER to take? (Please check all that apply)

In what areas do you hope your PEER will provide guidance? (Please check all that apply)

How would you prefer to communicate with your PEER? (Please check all that apply)

NACOLE PEER-TO-PEER SUPPORT PROGRAM