2. Instructions
   The purpose of this form is to submit a complaint of misconduct against an employee of the Clarke County Sheriff's Office. If you have an emergency, need to file a police report, or speak to a law enforcement officer about criminal activity, please call 911.
3. 
5. Your First Name*
6. Your Last Name*
8. E-mail Address*
9. Cell Phone Number*
10. Home Phone Number
12. Address
14. City
15. State
16. Zip
18. Date of Birth
19. Race

    1. White/Caucasian
    2. Black/African American
    3. American Indian/Alaska Native
    4. Asian
    5. Native Hawaiian/Pacific Islander
    6. Prefer Not to Say
20. Gender

    1. Male
    2. Female
    3. Other
    4. Prefer Not to Say
22. Occupation
23. Employer
24. Employer Contact Number
28. Incident Date and Time*
    Incident Date and Time

    Incident Date and Time
29. Incident Location*
31. Witnesses
33. Please describe basis for complaint or allegation of misconduct*
37. Name of Employee Involved
38. CCSO Vehicle #
39. Badge # (If Known)
41. Employee Description
42. Employee Race
43. Employee Gender
47. 2nd Employee Involved
48. CCSO Vehicle #
49. Badge # (If Known)
51. 2nd Employee Description
52. 2nd Employee Race
53. 2nd Employee Gender
57. Additional Information
59. 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.
61. Delivery options:
    This form will be submitted automatically and you may choose to receive a confirmation email. You may also choose to print and deliver or mail to Clarke County Sheriff's Office, 325 E. Washington Street, Athens, GA 30601.
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field