Complaint Form

Name:

Date:

Type of Incident:

Assault Alcohol Fraud Harassment Theft Vandalism to Auto Vandalism to Building Other(specify in description)

Location of Incident

Description of Incident

Be as detailed as possible

Gender of Offender/Suspect

Male Female Unknown/Unsure

Race of Suspect

Description of Offender/Suspect

Include age, hair color, height, weight, clothing, distinguishing marks, any words spoken, etc.

Name of Offender/Suspect (if known)

Address of Offender/Suspect (if known)

Description of Vehicle (if applicable)

Any other relevant information