Complaint Form UIC Police Department Complaint Form Name * Required First Last Address * Required Street Address City State / Province / Region ZIP / Postal Code Phone Number * RequiredAlternate PhoneEmail address * Required Best Time of Day to Contact You * RequiredPlease indicate what day of the week is best to contact you: * Required Sunday Tuesday Thursday Saturday Monday Wednesday Friday Who is this complaint against? * Required Police Officer* Police Telecommunicator Security Guard/Officer Other PD Civilian Employee *Please note: If you checked Police Officer, you will be contacted by the Internal Auditing Unit Supervisor to complete a sworn signed affidavit to accompany this complaint. This is an Illinois law and cannot be avoided. Complaints against any other UICPD employee do not require and affidavit.INCIDENT INFORMATIONAddress of Occurrence * Required Street Address City State / Province / Region ZIP / Postal Code Date of Incident - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Time of Incident * RequiredName of Employee (if known) First Last Badge Number (if known)If Name or Badge number is not known, provide a physical description.Description of the Incident * RequiredPlease be as detailed as possible. Do not leave anything out no matter how insignificant or significant you feel it is. The more information, the better.FilePlease provide any supporting documentation.FilePlease provide any supporting documentation.FilePlease provide any supporting documentation.FilePlease provide any supporting documentation.Form SubmissionBy submitting this online complaint form you are authorizing the UIC Police Department to investigate this matter. I understand that if I knowingly provided false information on this form I can be subjected to criminal and/or civil prosecution for filing a false report. I further understand that if this complaint is against a sworn police officer, per Illinois law, I MUST respond to the UIC Police Department and sign a sworn affidavit to accompany this complaint or this matter will not be investigated. By providing my identifying information in a digital format I am authorizing this complaint to be submitted and investigated. If this complaint is against a civilian employee, an affidavit is not required.Name * Required First Last Drivers License Number (DLN)Date of Birth - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Date Complaint Submitted - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY By providing the above identifying information, I authenticate the transmission of this online complaint form and believe this complaint to be accurate and true.EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.