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           CALIFORNIA STATE UNIVERSITY 
           POLICE DEPARTMENT 
           HAYWARD, CA 94542-3053 
           (510) 885-3791     FAX (510)885-3594       


  

Commendation and Complaint Form

PLEASE COMPLETE ALL APPLICABLE SECTIONS:

This is a:Commendation    Complaint   
I am a:Student    Faculty Member    Staff Member    Community Member
Day: Todays' Date: Current Time:
I filled out this form On the Web In Person Mailed It  Faxed It

Reporting Party:

My Last Name:
My First Name:
My Street Address:
My City:
My Zip:
My Telephone:
My Email:

Witness(s):

First:

Last Name:
First Name:
Street Address:
City:
Zip:
Telephone:
Email:

Second:

Last Name:
First Name:
Street Address:
City:
Zip:
Telephone:
Email:

Third:

Last Name:
First Name:
Street Address:
City:
Zip:
Telephone:
Email:

Circumstances:

Day: Date: Time:
Location:

Name (if known) or description of Officer(s) involved:

Description of incident:

E-mail address: