ACCPD Online Complaint Form

2. Instructions
   The purpose of this form is to submit a complaint of misconduct against an employee 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 submit a complaint of misconduct against an employee 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. Your First Name*

5. Your Last Name*

7. E-mail Address*

8. Cell Phone Number*

9. Home Phone Number

11. Address 1

13. City

14. State

15. Zip

17. Date of Birth

18. 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

19. Gender

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

21. Occupation

22. Employer

23. Employer Contact Number

27. Incident Date and Time*
    Incident Date and Time

    Incident Date and Time

28. Incident Location*

29. Case Number (If Known)

31. Please describe basis for complaint or allegation of misconduct*

35. 1st Officer Name

36. ACCPD Vehicle #

37. Badge # (If Known)

39. 1st Officer Description

40. 1st Officer Race

41. 1st Officer Gender

45. 2nd Officer Name

46. ACCPD Vehicle #

47. Badge # (If Known)

49. 2nd Officer Description

50. 2nd Officer Race

51. 2nd Officer Gender

55. 3rd Officer Name

56. ACCPD Vehicle

57. Badge # (If Known)

59. 3rd Officer Description

60. 3rd Officer Race

61. 3rd Officer Gender

63. Additional Information

65. Affirmation*

    I HEREBY AFFIRM THAT THE FOLLOWING INFORMATION PROVIDED BY ME IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

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


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

    This field is not part of the form submission.

69. Submit

* indicates a required field