Special Needs Individual Request – Orange County NC Sheriff's Office

Thank you for taking this step and partnering with us in order to more efficiently and appropriately respond to public safety incidents concerning your loved one. Please complete the following form, ensuring you also attach a recent color photograph.
Part 1. Requestor Information
Requestor Name*
First Last
Requestors Relationship to Special Needs Individual*
Requestors Address*
Street Address Address Line 2 City State ZIP Code
Requestors Home Phone
Requestors Cell Phone
Requestors Work Phone
Requestor Email Address
Enter Email Confirm Email
Part 2. Special Needs Individual's (SNI) Information
SNI Name*
First Last
SNI Sex*
- Female
- Male
SNI Birth Date*
MM slash DD slash YYYY
Post Image
Accepted file types: jpg, jpeg, png, gif.
SNI Address*
Street Address Address Line 2 City State ZIP Code
Will SNI need Life Track?*
- Yes
- No
Thank you for providing the requested information.
Should you have any questions about this initiative,
please contact:

OCSO Community Services: 919.245.2900

Upon receipt of your request a deputy from OCSO
will contact you for a follow-up visit and complete
the enrollment process.