CSUF Police Department's Cultural Competency Initiative (CCI) Public Interest Form

CSUF Police Department's

Cultural Competency Initiative (CCI) Public Interest Form

Thank you for your interest in participating in our Cultural Competency Initiative.

The Cultural Competency Initiative is an internal diversity, equity, and inclusion training and awareness component that celebrates diversity of thought, beliefs, abilities, perspectives, professions, and backgrounds that fosters an open-minded culture and respectful two-way dialogue.

We would like to invite diverse community voices to meet with police personnel to discuss a wide range of topics you choose.

We have no agenda and will not set the tone for the conversation, that will be all up to you.

How It Works

Complete the Public Interest form

If chosen, you will have 45 minutes during a morning or evening briefing at our police station to discuss what makes you uniquely you or information that you believe would be helpful to department personnel and to increase their cultural competency and awareness.

(Briefing Times: 7:00 a.m. - 7:45 a.m. or 6:30 - 7:15 p.m.)

Only one community member at a time will be invited to meet with department personnel.

Sworn personnel will be in full uniform along with students and professional staff.

You will speak with personnel in person and simultaneously via Zoom which will be recorded.

Submission of the form is not a guarantee of participation.

We understand some members of the community might wish to use this time to discuss challenges they've faced with law enforcement personnel; however, this program is specifically geared towards us learning more about each other.

If you wish to discuss challenges or concerns you've personally experienced with law enforcement, please email upd.pio@fullerton.edu.

If you would like to speak with someone from CSUF Police Department prior to submitting your request, please email Marissa Garza at magarza@fullerton.edu.

First Name*

Last Name*

Contact #*

Phone

Contact Email*

Select the option below that best represents you*

Select

Select your age range*

If you select 16 - 17, we require written permission from your parent or guardian, a meeting prior to the discussion, and their presence on the day of the meeting.

Select

Parental or Guardian Consent for a Minor*

I certify that I am legally responsible for the minor named above and give my consent for the minor to meet with members of the CSUF Police Department.

By selecting "Yes" below, you have given written permission for the minor to participate in our CCI, you agree to a Zoom, phone, or in-person discussion prior to scheduling a date, and you will be present with the minor for the entirety of the discussion.

Select

Parent or Guardian Name*

Parent or Guardian Contact #*

Phone

Parent or Guardian Email*

Relationship to Minor*

Select

What do you plan to discuss?*

Topics could include your professional experiences that differ from law enforcement. Some aspects of your religion, cultural beliefs, practices, or feelings. Your military experience, a physical or mental disability, or details about your country of origin, just to name a few.

Please be as thorough as possible.

Do you represent a group, organization, or dept.?*

Select

Name of group, organization, or department?

Biography*

Please provide us with a short biography. This information will be used as an introduction for our personnel and for marketing purposes.

Please do not include information you do not want made public.

How did you hear about the initiative? *

Select

Specify how you heard about the program (Other)

Additional Information

Use this section to include additional information you would like CSUF Police Department to know

Consent*

I consent to a Zoom, phone, or video recording of my involvement with the CSUF Police Department's Cultural Competency Initiative.

I consent to allow them to use the recording and/or photographs to train CSUF Police Department personnel or community members in the future without my presence.

I consent to allow portions of the recording, photographs, or a written transcript in part or in whole to be used on social media, websites, in newsletters, presentations, and in any other way CSUF Police Department deems appropriate.

I understand that CSUF Police Department may edit portions of recorded segments or transcribe certain aspects into written form.

If you plan to discuss anything confidential or private (e.g. citizenship, sexual assault, etc.) and you wish to keep a small portion from the public, please choose "Partially" and provide the details you do not want made public.

Yes

Partially

If you selected "Partially," please explain

If you selected "NO," participation in the CSUF Police Department's Cultural Competency Initiative (CCI) is not possible at this time.

We thank you for your interest and we hope to see you at some of our community events throughout the year.

Send me a copy of my responses

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