Language
English (US)
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Citizen Arrest Report Form
Please submit your responses below if you are a Citizen and have been arrested by immigration enforcement agents. In order for us to better assist you, please provide as much detail as possible.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date & Time of Arrest (enter approximate time if uncertain)
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Arrest (provide nearest exact address if uncertain)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long were you detained (and where)?
*
Was there any use of force?
Please Select
Yes
No
Please share details about use of force
Were there any comments made by arresting agents?
Please Select
Yes
No
Please share details about comments made.
Is there anything else you would like to share? (e.g., other arrests and/or law enforcement in the area)
Please verify that you are human
*
Submit
Should be Empty: