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?

Street Address (Optional)

City

State

ZIP Code

Demographic Information

For Statistical Purposes Only The Department of Justice and the Civilian Police Oversight Agency are requesting this information for statistical purposes. If you chose not to answer, please check the 'prefer not to answer' selection. We value your participation, please help our Agency track biases and trends.

Gender  

Female
Male
Other
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Race  

Asian
Black
Mixed Race
Native American
Pacific Islander
White
Other
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Ethnicity

Hispanic
Non-Hispanic
Prefer not to answer

Sexual Orientation  

Asexual
Bisexual
Heterosexual
Homosexual
Other
Prefer not to answer

Do You Have a Mental Illness?  

Yes
No
Prefer not to answer

Do You Struggle with Homelessness?  

Yes
No
Prefer not to answer

Were you homeless at the time of this incident?  

Yes
No
Prefer not to answer

Incident Information

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

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?  

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