Complaint Form

Instructions

This form is intended for use by those who wish to file a complaint against a UCLA Police Officer(s) for misconduct and who seek formal investigation of the matter by the Compliance Office.

Important information about filing a complaint

Individual complaints should be filed as soon as possible after the incident.
Please provide as much information as possible about the incident.

Complaint Information

First

Last

Email address

Address

Primary phone number

Alternate phone number

If you received any injuries as a result of this incident, please describe them here.

Incident Narrative

Date of the incident

Time of the incident

Where specifically did the incident occur?

Please describe the incident that forms the basis of your complaint. It is important that you include a detailed, factual description of the events that gave rise to your complaint.

Document Upload

Upload documents or evidence related to the incident to Box.

Police Officer Information

Badge information (if known)

Name of Police Officer (if known)

Physical description of Police Officer (if badge or name not known)

Witness Information

Witness 1

Witness name (if applicable)

Witness phone (if applicable)

Witness email (if applicable)

Witness address (if applicable)

Witness 2

Witness name (if applicable)

Witness phone (if applicable)

Witness email (if applicable)

Witness address (if applicable)

Witness 3

Witness name (if applicable)

Witness phone (if applicable)

Witness email (if applicable)

Witness address (if applicable)

Certification

By checking this box, I understand and acknowledge that it is against the law to make a complaint that I know to be false. If I make a complaint against an officer knowing that it is false, I can be prosecuted on a misdemeanor charge. I certify that the information I am providing is true and correct, to the best of my knowledge.

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