Rhode Island State Police Complaint / Compliment Form
Your Information
Full Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mobile Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Other Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mailing Address (If Different From Above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Incident Information
Date of Incident
-
Month
-
Day
Year
Date
Time of Incident
Hour Minutes
AM
PM
AM/PM Option
Citation / Report Number
Location/Address of Incident
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Information of Witnesses to Incident
Name
First Name
Last Name
Relation to Witness
Address
Telephone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name
First Name
Last Name
Relation to Witness
Address
Telephone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Identity of Trooper / Employee
Name and / or Rank of Trooper or Employee
Badge Number of Trooper
Description of Police Vehicle
Description of Incident
If this is a complaint being filed under the Rhode Island State Police Title VI Program, which prohibits discrimination based on the following categories, please identify the basis under which your complaint is being filed.
Race
Color
National Origin
Sex
Age
Disability
Income Level
Limited English Proficiency
Please verify that you are human
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