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Complaint Against On-Duty Security Personnel

Name of Complainant:

   

Address you can be contacted at: (required field)

   

Email:

   

Cell Phone:

   

Home Phone:

   

Work Phone:

   

Date of Incident:

   

Time of Incident:

   

Location of Incident: (required field)

   

Name of officer against whom complaint is being filed:

   

Or other identifying marks (car number, badge number, etc.)

Rank:

   

Badge Number:

   

Vehicle Number:

   

Other Identification:

   

Other witnesses (names, addresses, phone numbers):

   

Statement of allegation: (required field)

   

I understand that this Complaint will be submitted to the Director of Campus Security and may be the basis for an investigation. I declare that the information contained herein is accurate and true to the best of my knowledge and belief. Further, I declare and affirm that this statement is made by me voluntarily without coercion of any kind.

Campus Security
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