Survey & Form Center

Please note there is no log-in required to submit this or any other form in the Form Center.
Please make sure to save progress if you are not finished with the form and are exiting the page.
By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

STRIVIN' Testimonals

    COMBAT is conducting this survey, so that we can hear from you, individuals directly involved in our Striving Together to Reduce Violence In Neighborhoods (STRIVIN’) initiative. We are collecting your testimonials to help raise awareness about STRIVIN’ through our website and social media channels—and to let your words "speak" for the initiative as we seek to encourage others to strive with us to make every neighborhood a safe place to call home.

    Please take just a few minutes to fill out this survey.

    Thank you.

    COMBAT Director Vince Ortega
  3. Important
    To submit this form you do not have to sign or create a Form Center account above. However, you will have to complete the form in its entirety without the option to save your progress unless you do create an account.
  4. Your STRIVIN' Neighborhood*
    Check each STRIVIN' Neighborhood in which you or your organization participate.
  5. In A Sentence Or Two
    Or however many you'd like, please answer these three questions?
  6. Leave This Blank:

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