University Police Department
Official Complaint Form
Complainant Information
Name:
T Number:
Primary Phone
Number:
Email Address:
Mailing Address:
Alternate Phone
Number:
Incident Information
Date of Incident:
Time of Incident:
Location of
Incident:
Name(s) of
Officer(s) Against
Whom Complaint
is Being Filed
Narrative/Incident Details
Please describe the incident precipitating the complaint to the best of your ability.
Narrative: