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2. COFFEE WITH A COP HOST APPLICATION
   Host locations must be open to the public, and be able to provide coffee to the patrons. Sessions are two-hours in length, and can be scheduled on mutually agreed upon dates.
4. Applicant's Name:
6. Applicant's Phone Number:
7. Applicant's email address:
9. Location for Coffee with a Cop event to be held:
11. Location address in Canton:
13. Main cross-roads of location:
15. Briefly describe the location type:
    Example: Neighborhood clubhouse, coffee shop, church, etc...
17. Please list when you'd like to host the event:
    Include month of interest and day, evening, weekend, etc...
19. Applicants will be contacted by someone from the department to schedule this event.
    If you do not hear back within 10 days, please call 734/394-5401 to inquire.
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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