2. Baton Rouge Police Department

   9000 Airline Highway
   Baton Rouge, Louisiana 70815
   Emergencies dail 911
   Non emergencies (225)389-2000
4. 1. Are you a resident of Baton Rouge, Louisiana?

   1. Yes
   2. No
6. 2. Have you had contact with Baton Rouge Police Department within the last year?

   1. Yes
   2. No
8. 3. Under what circumstance did you have contact with the Baton Rouge Police Department?

   1. Traffic
   2. Home/Neighborhood
   3. Business
   4. Other
10. 4. Was the Officer able to address your concerns in a manner that was satisfactory?

    1. Yes
    2. No
12. 5. While in contact with the Officer, do you feel that you were treated respectfully?

    1. Yes
    2. No
14. 6. Do you feel that officer's response times are sufficient?

    1. Yes
    2. No
16. 7. Please select three (3) issues you feel are the greatest problems with your community

    1. Burglaries/thefts
    2. Child Abuse
    3. Child Predators
    4. Disorderly behavior
    5. Domestic violence
    6. Drug Abuse
    7. Fraud
    8. Gang Activity

    1. Gun violence
    2. Hate Crimes
    3. Homeless(panhandling)
    4. Homicide
    5. Prostitution
    6. Sexual assault
    7. Traffic
    8. Vandalism/graffit
18. 8. What improvements or changes would you like to see implemented with the Baton Rouge Police Department?
20. 9. Do you feel safe in your neighborhood/home?

    1. Yes
    2. No
22. 10. What is your gender?(optional)

    1. Male
    2. Female
24. 11. What is your age? (optional)

    1. 18 to 24
    2. 25 to 34
    3. 34 to 44
    4. 45 to 54
    5. 55 to 64
    6. 64 to 75
    7. 72 or older
26. 12. What is your overall rating of the Baton Rouge Police Department?

    1. Excellent
    2. Good
    3. Fair
    4. Poor
28. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
30. Electronic Signature
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