2. Citizen's Information
4. Type of Feedback

   1. Allegation of Misconduct
   2. Compliment
   3. Request
   4. Suggestion
   5. Racial or other biased-based profiling
6. Last Name
7. First Name
8. MI
9. Date of Birth
11. Race
12. Sex
14. Home Address
15. City
16. State
17. Zip
19. Primary Telephone

    Contact information is not required, however, we will need your information if you would like to be contacted about the incident.

20. Secondary Contact
21. Email

    Contact information is not required, however, we will need your information if you would like to be contacted about the incident.

23. Witness Information
25. Last Name
26. First Name
27. MI
28. Date of Birth
30. Race
31. Sex
33. Home Address
34. City
35. State
36. Zip
38. Primary Telephone
39. Secondary Contact
40. Email
42. Employee Information
44. Name of Officer/Employee (IF KNOWN)
45. Badge #
47. Physical Description of Officer/Employee
49. Date of Incident
50. Time of Incident
51. Location of Incident
53. Arrested?

    1. Yes
    2. No
54. Case # of Arrest (If Applicable)
55. Citation Issued?

    1. Yes
    2. No
56. Citation Number and Court Date (If Applicable)
58. Description of Incident in Detail
60. How would you like to see this complaint resolved?
62. Date of Form Submission
Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit

* indicates a required field