Training and Technical Assistance Request Form
Serving Safely is supported by the Bureau of Justice Assistance Training and Technical Assistance Initiative to Improve Police-Based Responses to Persons with Mental Illnesses and/or Intellectual and Developmental Disabilities.

Our mission is to help support enhanced interactions between police and persons with mental illnesses and/or developmental disabilities.

To request training or technical assistance for a law enforcement agency, please fill out this form. The Vera Institute of Justice will review all requests and respond within three business days. At that time, staff will gather additional information to determine how best to assist you.

Should you have any questions, need help completing the form, or require a disability-related accommodation, please call 212-376-3074 or email

Email address *
Professional Title
Your answer
Your Full Name *
Your answer
Phone Number *
Your answer
Preferred Contact Method *
Best Time of Day to Reach You *
Include PT, MT, CT, ET (For example, Monday afternoons after 3 p.m. PT)
Your answer
Agency or Organization Name *
Your answer
Agency or Organization's Address *
Street, City, State, Zip Code
Your answer
Organization Type *
Select One
Identify the Nature of Your Training/Technical Assistance Request *
Check all that apply (may use Additional Comments section to provide details)
Did your agency experience an incident within the last 12 months prompting this training or technical assistance request? *
Describe your target audience *
Select all that apply
Additional Comments *
Relative to your request, is there something we did not ask that you believe we should know about your organization or the community you serve?
Your answer
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