Safe House Application: For Homes

All online applications will be submitted to the Safe House program coordinator, the Police Community Liaison with the Dallas Police Department. Once your application has been submitted, processed and approved, the Safe House coordinator will reach out to set up your Safe House visit!

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About the Applicant

First Name: *

Middle Name:

Last Name: *

Maiden Name:

Phone Number: *

Date of Birth: *

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Sex: *

ODL: *

Race: *

Address: *

Place of Employment: *

About the Household: If Applicable

Spouse First Name:

Spouse Middle Name:

Spouse Last Name:

Spouse Maiden Name:

Phone Number:

Date of Birth:

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Sex:

ODL:

Race:

Address:

Place of Employment:

Please list any resident's 12 years or older. In addition, please include daily or weekly household help.

First and Last Name:

Date of Birth:

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ODL:

Sex:

Phone Number:

Race:

Address (if different):

First and Last Name:

Date of Birth:

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ODL:

Sex:

Phone Number:

Race:

Address (if different):

First and Last Name:

Date of Birth:

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ODL:

Sex:

Phone Number:

Race:

Address (if different):

First and Last Name:

Date of Birth:

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ODL:

Sex:

Phone Number:

Race:

Address (if different):

As a volunteer for the Safe House program, I hereby authorize the Dallas Police Department to conduct a background investigation to determine the qualifications of this household to participate in this program. (E-Signature and Date below)

Applicant Signature: *

Date:

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Comments:

Safe House Application: For Homes

Contact Information

Thomas Simpson

Chief of Police

Hours