City of Victoria Form Center

2. Community Outreach Inquiry
   Please fill out this form to request Municipal Court to be a presenter at your event, to partner with the Municipal Court for an event, or to request traffic safety related materials. The court will contact you once this request is confirmed and verified with the court personnel. If you have any questions regarding this form, you may all the court at 361-485-3050 or e-mail courtclerk@victoriatx.gov.
4. Organization Name*
   Please enter the name of the organization making a request.
5. Contact Name*
   Please enter your first and last name.
7. E-mail address*
   Enter the e-mail address that you would like to be contacted at.
9. Address*
   Please enter the street number and address of the location of the organization or event.
11. City*
12. State*
13. Zip Code*
15. Contact Phone # *
16. Alternate Phone #*
18. Type of Event*
    Detail the type of event and what the expectations are.
20. Target Audience*
    Please describe the target audience for event.
21. Expected # for Event*
    Please include an estimated number of people attending and/or estimated # of requested traffic safety related materials needed.
23. Date and Time of event *
    Date and Time of event Start Date

    Date and Time of event Start Time

    —

    Date and Time of event End Date

    Date and Time of event End Time
    Please include the date and Start and End time of event.
25. Community Outreach Options*

    Please check any community or traffic safety related initiatives you are interested in obtaining more information about.

    1. Mock Trials
    2. Traffic Safety Education
    3. Traffic Safety Related Materials
    4. Impaired Driving Education
    5. Facility Tour
    6. Virtual Education or Tour
    7. Java with the Judge
    8. Outreach Docket Initiative
    9. Career talk
    10. Other (Please detail below)
27. Other information*
    Please include any additional details. If no additional details, please put N/A
29. Presentation Materials Needed*

    Please check the appropriate box of what materials we need to bring for any presentations.

    1. None
    2. Laptop Computer
    3. Projector
    4. Projector Screen
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field