NACOLE Peer Support Program Application

NACOLE PEER-TO-PEER SUPPORT PROGRAM

Application to Participate
Name

First NameLast Name
Oversight Agency
Title
Address

CityState / Province

Postal / Zip CodeCountry
Email
example@example.com
Phone Number

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

Less than one year1-2 years3-5 years6-10 yearsMore than 10 years
How long has your agency been in operation?

Less than 1 year1-5 years6-10 years11-20 yearsMore than 20 years
What model of oversight is your oversight agency?

Review-Focused ModelInvestigative-Focused ModelAuditor/Monitor-Focused ModelHybridOther
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)

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

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

Knowldege and Practice of Professional EtiquetteFocus of Specific Fields of Practice Within Civilian OversightCrisis ManagementCorrectional OversightPolice Union IssuesPolicy DevelopmentCritical InvestigationsOther
How would you prefer to communicate with your PEER? (Please check all that apply)

Video ConferencePhoneEmailTextOther

NACOLE PEER-TO-PEER SUPPORT PROGRAM

Additional Information About Yourself