Complete the below form and "click" the submit button at the bottom of the page to file a report with USCP Office of Professional Responsibility. * marks required fields of data. Complainant Information Name: * Mailing Address: City: State: Zip Code: +4 Extension: Email: Phone Number * Phone Type: Standard voice telephoneVideophone [VP]Text-telephone device [TTD] What are these options? Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option "Voice" is a standard audible telephone. Race/Ethnicity: White Black or African American Hispanic or Latino American Indian or Alaska Native Asian Native Hawaiian or Other Pacific Islander Unknown Other Race: Gender: Male Female Other Gender: Date of Incident Time Of Incident (Ex. 02:00pm): * Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm USCP Employee Information Name(s)- If name is not known, enter "unknown": Include rank, badge and assignment for each employee, if known. Enter each employee on a separate line. Witness Information (If Applicable) Name: Include address and phone number for each witness, if known. Enter each employee on a separate line. Upload Additional Information: Additional Info: Files must be less than 2 MB.Allowed file types: jpg jpeg png pdf doc docx. Signature: * Typing your name and electronically sending this form constitutes your electronic signature and certifies that to the best of your knowledge the statements made herein are true, and you acknowledge that the making of false statements is punishable by criminal penalties. CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
