Contact Information

First Name:

MI:

 Last Name:

Title:

Name of the Organization You Belong to:

Address & telephone Information
 Street No

Street Direction:

 Street Name: Apt #:
 City:

State:

 Zip:
 Telephone Numbers:
 Daytime: - - Ext:
 Evening: - - Fax: - -
 Email:

Community Information

Police Precinct

Neighborhood City Hall Assigned

Data Entered in Neighborhood City Hall

Patrol a Neighborhood

 (October dates)

Designated Area to Patrol 

Watch a Vacant House/Structure

 (October dates)

Turn on my Porch Lights

 (October dates)

Address of vacant House/Structure

Data entry or other office Support

Number of additional Volunteers With Individual:

  

Age (Minor/Senior Citizen/No)

Volunteer Interests
 Previously Volunteered
 Other Volunteer Interests Motor City Makeover

For Additional Information,
Please call the Volunteer Office Number at (313) 224-4415