2. First Name*
3. Last Name*
4. Cell Phone Number
5. Home Phone Number
7. E-mail Address*
8. Do you wish to remain anonymous?

   1. Yes
   2. No
10. Address 1
12. Address 2
14. City
15. State
16. Zip
20. Date of contact with employee
    Date of contact with employee

    Date of contact with employee
21. Location of interaction
22. Case Number (if applicable)
24. Employee Name / Badge #
25. 2nd Employee Name / Badge #
26. 3rd Employee Name / Badge #
28. Car Number (if known)
30. Commendation Remarks*
    Use this field to provide details about your commendation
32. This form may be printed out and delivered or mailed to the Athens-Clarke County Police Headquarters (3035 Lexington Road, Athens GA 30605), emailed to police@accgov.com or submitted directly through this website form.
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field