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    Please fill out the form below as accurately and completely as possible. You do not have to leave identifying information such as your name and phone number, but if you do not leave that information we will not be able to follow up with you if we have additional questions once an investigation is started.

  2. Gender

  3. Race

  4. Ethnicity


  6. 999-999-9999

  7. 999-999-9999

  8. Approximate date and time if exact time is unknown

  9. Address or approximate location

  10. Nature of Complaint*

    Please select the option or options that best describes the nature of your complaint. You may select more than one option.

  11. Please fill out the name, approximate age and phone number of any witness to the events.

  12. As clearly and concisely as possible, please describe the incident in question.

  13. Signature or your typed name will be sufficient for this block

  14. Leave This Blank:

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