Albuquerque Police Complaint or Commendation Form

Mediation

Interested in Mediation?  

Yes
No
I need more information.

Contact Information

Information about you.

First Name (Optional)

Last Name (Optional)

Middle Name (Optional)

Home Telephone Please include area code. For example: 505-555-1234

Cell or Work Telephone Please include area code. For example: 505-555-1234

Best Time to Call What is the best time and day of the week to be contacted?

Your E-Mail Address (Optional)

Preferred Language

Date of Birth What is your date of birth?

Year -- 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 / Month -- January February March April May June July August September October November December / Day -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  

Street Address (Optional)

City

State

ZIP Code

Demographic Information

Optional: For Statistical Purposes Only The Department of Justice and the Civilian Police Oversight Agency are requesting this information for statistical purposes. It is optional to answer these background questions. We value your participation, please help our Agency track biases and trends.

Gender (Optional)

Female
Male

Race (Optional)

Asian
Black
Mixed Race
Native American
Pacific Islander
White
Other

Ethnicity (Optional)

Hispanic
Non-Hispanic

Sexual Orientation (Optional)

Asexual
Bisexual
Heterosexual
Homosexual
Other

Do You Have a Mental Illness? (Optional)

Yes
No

Do You Struggle with Homelessness? (Optional)

Yes
No

Were you homeless at the time of this incident? (Optional)

Yes
No

Incident Information

Date & Time of the Incident When did the incident that you are reporting happen?

Year -- 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 / Month -- January February March April May June July August September October November December / Day -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Hour -- 12 01 02 03 04 05 06 07 08 09 10 11 : Minute -- 00 05 10 15 20 25 30 35 40 45 50 55 AM/PM -- AM PM

Address or Location of the Incident Where did the incident take place. If possible, please specify an address.

Information about the Albuquerque Police Department Employee(s) Involved:

Police Employee #1 - Name

Police Employee #1 - ID or Badge Number

Police Employee #2 - Name

Police Employee #2 - ID or Badge Number

Are You Submitting this Form for Someone Else?

Yes
No

Submitting for Someone Else - if "Yes" If you are submitting this form for someone else, what is that person's name and telephone number?

Did You Witness this Incident?

Yes
No

Additional Witness Please list any additional witnesses, as well as their Telephone and Address contact information.

Statement   Briefly summarize what happened. It is important to provide as much information as possible describing the incident in full detail, including: Location, Date, Time, Officer(s) or Employee(s) Involved, and Witnesses. Additional APD Officer and/or APD employee information should be listed here as well. If names are not known, please include a detailed description of the Officer(s) involved.

What Outcome are you Seeking?