search
Social Media Facebook Twitter Instagram Linkedin Youtube

Cowley Locations

Campus Security & Public Safety

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.