Law enforcement and community engagement form

On a scale of 1 through 10, how would you rate the Safety of your community? *

10 being the highest-very safe and 1 being the lowest-not safe at all.

Describe why you selected that rating? *

Name *

Email *

What is your zip code? *

Describe the types of things your community needs? *

Are there sidewalks in your community? *

Do you feel safe in your community? *

Describe what would make you feel safer? *

What has caused you to feel safe or unsafe in your community? *

Do you believe it is everyone's responsibility to be responsible? *

How can we work together to get each other home safe? *

Upload Video or pictures of any examples to help support your responses

Click or drag files to this area to upload. You can upload up to 15 files.

Online Video and Picture Submission Agreement *

By submitting your video, you are representing to MyCulpability.com that you have all necessary rights in the video to authorize our use and reuse of the audio and visual material it contains, that your submission of the video is governed by our On Line Video Submission Agreement, and that you have read, understood and agreed to the terms and conditions of that Agreement.