ACCPD Complaint Form

2. Instructions

   The purpose of this form is to file complaints of alleged misconduct from members of the Athens-Clarke County Police Department. If you need to file a police report or speak to an officer about criminal activity, please call 706-546-5900.

   The purpose of this form is to file complaints of alleged misconduct from members of the Athens-Clarke County Police Department. If you need to file a police report or speak to an officer about criminal activity, please call 706-546-5900.

4. I want to
   -- Select One --inquire about a policy, procedure, or processfile a formal complaint against an officer(s)

6. Your First Name*

7. Your Last Name*

9. E-mail Address*

10. Cell Phone Number*

11. Home Phone Number

13. Address 1

15. City

16. State

17. Zip

19. Date of Birth

20. Race

    1. White/Caucasion
    2. Black/African American
    3. American Indian/Alaska Native
    4. Asian
    5. Native Hawiian/Pacific Islander
    6. Prefer Not to Say

21. Gender

    1. Male
    2. Female
    3. Other
    4. Prefer Not to Say

23. Occupation

24. Employer

25. Employer Contact Number

29. Incident Date and Time*
    Incident Date and Time

    Incident Date and Time

30. Incident Location*

31. Case Number (If Known)

33. Please describe basis for complaint*

37. 1st Officer Name

38. ACCPD Vehicle #

39. Badge # (If Known)

41. 1st Officer Description

42. 1st Officer Race

43. 1st Officer Gender

47. 2nd Officer Name

48. ACCPD Vehicle #

49. Badge # (If Known)

51. 2nd Officer Description

52. 2nd Officer Race

53. 2nd Officer Gender

57. 3rd Officer Name

58. ACCPD Vehicle

59. Badge # (If Known)

61. 3rd Officer Description

62. 3rd Officer Race

63. 3rd Officer Gender

65. Additional Information

67. Affirmation*

    I HEREBY AFFIRM THAT THE FOLLOWING INFORMATION PROVIDED BY ME IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT ANY FALSE, MISLEADING OR UNTRUE STATEMENTS, ACCUSATIONS, OR ALLEGATIONS MADE BY ME, EITHER ORALLY OR IN WRITING, TO ANY PERSON(S) INVESTIGATING THIS COMPLAINT MAY SUBJECT ME TO CIVIL AND/OR CRIMINAL PROSECUTION. I REALIZE THAT IT MAY BECOME NECESSARY FOR ME TO MEET WITH A MEMBER(S) OF THE ATHENS-CLARKE COUNTY POLICE DEPARTMENT TO DISCUSS THIS COMPLAINT, EITHER IN THE PRESENCE OR ABSENCE OF THE ACCUSED DEPARTMENTAL EMPLOYEE(S) AT THE DIRECTION OF THE DEPARTMENT. I ACCEPT THE PREMISE THAT IF ANY ACTION IS INITIATED THROUGH A COURT OR ADMINISTRATIVE HEARING AS A RESULT OF MY COMPLAINT, MY TESTIMONY BEFORE THESE HEARINGS MAY BE REQUIRED. I HEREBY AGREE TO MAKE MYSELF AVAILABLE TO THE AFOREMENTIONED COURT OR ADMINISTRATIVE HEARING WHEN REQUESTED TO DO SO.

    1. I have read and understood the above admonition.
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field