University Police - Civilian Complaint Report

Civilian Complaint Report
If you wish to make a complaint alleging misconduct by a Southern Police Officer please complete the online or downloadable PDF forms. The Southern Police complaint and investigation policy is available for your review. This form is not intended for anyone wishing to file a police report or for reporting a crime.

Southern Police Complaint and Investigation Policy
Download PDF Form
Download PDF Form (Spanish)
Date / Time of Incident *

Month Day Year
Date Hour Minutes AM/PM Option
Location of Incident
Complainant Information
Complainant's Name *

First Name Last Name
Complainant's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Complainant's Date of Birth

Month Day Year
Date
Complainant's Home Phone *

Area Code Phone Number
Complainant's Work Phone

Area Code Phone Number
Complainant's Cell Phone *

Area Code Phone Number
Complainant's Email *
Employer Information
Employer
Occupation
Employer's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Employer's Phone

Area Code Phone Number
Person Assisting Complainant
Name of Person Assisting Complaint

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Complaint
Employee Complained About (if known)
Name or physical description, Badge #, Car #, etc.
Witness Information
Name, D.O.B., Address, Telephone #, etc.
Please Provide Answers to the Following Questions
1. To your knowledge, was all or any part of the incident complained of video or audio taped by anyone? *
2. Are you afraid for your safety, or that of any other person, for any reason as a result of making this complaint? *
3. Has anyone threatened you or otherwise tried to intimidate you in an effort to prevent you from making this complaint? *
4. Are you able to read, write and speak the English Language? *
5. If your answer to Question #4 is “No” or “Unsure”, have you been provided with adequate language assistance to help you understand and fill out this form? *
(If you answered "Yes" to any of the above questions, please provide details below.)
Details of the Incident: Please provide a full description of the circumstances that prompted your complaint. Attach supporting documentation, as appropriate; including letters, e-mails, photographs, and video or audio tapes, etc.
Should be Empty:

Civilian Complaint Report

Complainant Information

Employer Information

Person Assisting Complainant

Complaint

Please Provide Answers to the Following Questions