To be completed by a Law Enforcement Officer who is DIRECTLY working with the person in need.

**AoP WILL NOT provide assistance if an officer is called out by Crisis, a Victim Advocate, community member, another nonprofit agency, etc., solely to place a request to AoP.* This does not meet our mission as an officer should not have been called out for a "211" issue.

Officer first name *

Officer last name *

Officer's email *

Officer's call back number - (this is for AoP to contact upon receiving request) We don't share your #. *

Agency *

LEO's Badge # - Precinct - Assignment *

Incident Information

Incident # - If applicable

What was the call for service/or reason for LEO contact? *

Homeless Request? REMINDER: AoP is extremely limited when working with the homeless, as most do not require PD (911), but require social services (211). Please provide families with the Family Housing HUB # 602-595-8700 so they may get on the list asap, in lieu of placing a request to AoP.

Current location of person needing assistance *

Information for Individual Being Assisted by this Request

Main Contact's First Name *

Main Contact's Last Name *

Street Address

City

State

Zip Code

Phone Number

Client's Email Address

Gender *

Male

Female

Age *

Race *

Additional Individuals On-Scene

# of adults requiring assistance *

# of youth requiring assistance *

Additional information you'd like to share about individual/family

Request of Angels on Patrol

What is your request of Angels on Patrol? *

If applicable, list what other resources were sought prior to submitting request to AoP.

After Hours Request - Between (1900-0700 hours Monday - Friday or weekend & holidays)

Was an After Hours Visa Card used? *

If After Hours card was used, please provide what it was used for. ** If used for a motel: What motel and room #. ** Thank you for returning the AH card and sending a copy of the receipt to accounting@angelsonpatrol.org

White, non-Hispanic	Hispanic
Asian/Pacific	Black, non-Hispanic
Alaskan/Native American	Unknown
Other Other