NACOLE Peer Support Program Application

NACOLE PEER-TO-PEER SUPPORT PROGRAM

Application to Participate
Name

First Name Last Name
Oversight Agency
Title
Address

City State / Province

Country
Email
example@example.com
Phone Number

Area Code Phone Number
How long have you worked in the field of civilian oversight?

Less than one year 1-2 years 3-5 years 6-10 years More than 10 years
How long has your agency been in operation?

Less than 1 year 1-5 years 6-10 years 11-20 years More than 20 years
What model of oversight is your oversight agency?

Review-Focused Model Investigative-Focused Model Auditor/Monitor-Focused Model Hybrid
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/Patrol Jail Prison
Which of the following adjectives best describe you? (Please check all that apply)

Outgoing Constructive Energetic Passionate Reflective Humorous Business-Oriented Empathetic Intuitive Reserved Vibrant
What role would you like your PEER to take? (Please check all that apply)

Colleague Teacher Listener Motivator Career Development Coach
In what areas do you hope your PEER will provide guidance? (Please check all that apply)

Knowldege and Practice of Professional Etiquette Focus of Specific Fields of Practice Within Civilian Oversight Crisis Management Correctional Oversight Police Union Issues Policy Development Critical Investigations
How would you prefer to communicate with your PEER? (Please check all that apply)

Video Conference Phone Email Text

NACOLE PEER-TO-PEER SUPPORT PROGRAM

Additional Information About Yourself