SANTA ANA POLICE DEPARTMENT
REQUEST FOR PUBLIC SPEAKING
This form is to be completed by requesting agency or person, for an officer of this
department to give a talk or participate in any way in discussing departmental functions.
Upon completion of this form, the Chief of Police or his designee will make the necessary
confirmation with the person (s) requesting the service, if approved.
DATE AND TIME OF REQUEST ___________________________________________
NAME OF PERSON MAKING REQUEST ____________________________________
ADDRESS ________________________________PHONE NO. ________________
ORGANIZATION REQUESTING TALK ______________________________________
DATE, TIME AND LOCATION OF TALK_____________________________________
SUBJECT AND TIME ALLOTTED FOR PRESENTATION _______________________
DESCRIBE TYPE OF PRESENTATION REQUESTED (Panel, Group, Single Speaker, etc.)
(If panel, name of other panelist members) ______________________________
HOW MANY EXPECTED TO ATTEND ______________________________________
WILL THERE BE ANY EXPENSE TO OFFICER IN ATTENDING LUNCH, ETC. ______
IF APPROVED, WHO IS TO BE CONTACTED:
_____________________________________________________________________
(Give name, address, & phone number)
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To be completed by Chief or his designee
Approved ___________Disapproved ___________ ___________________________
Signature
Officer assigned to give talk: ______________________________________________
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To be completed by the officer making presentation
1. How many in attendance: __________________
2. How was the lecture received? (Officer’s opinion)________________________
_____________________________________________________________________
3. Was there any disagreement by audience with the material? If yes, explain on reverse
side of this report.
4. Were there any questions asked of officer that he couldn’t answer?
5. What part of speech or discussion interested the audience most
