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5-On-5 Community Program Registration Form

  1. Thank you for your interest in participating in the 5-On-5 conversation with the Carbondale Police Department. We hope that this conversation provides information that will build relationships for the betterment of our community.

  2. Please select a date of availability:*
    1. Please submit five questions you would like to address to law enforcement:
    2. *Submissions will be reviewed and individuals who are not selected will be placed on an alternate list.

    3. If you have any questions, please do not hesitate to contact the Diversity, Equity, & Inclusion Officer:

      Sharonda Cawthon
      (618) 457-3228
      Email Sharonda Cawthon

    4. Leave This Blank:

    5. This field is not part of the form submission.