MSU Police Online Complaint Form

Section 2: Officer Information

Police Department

Officer's Name and Badge Number

Physical Description of Officer(s)

Police Vehicle Number or Description

Section 3: Medical Information

Describe Any Injuries

Where Treated

Section 4: Incident Information

Location of Incident

Date and Time of Incident

Add witness(es) Name, Telephone Number, or Other Contact Info

Describe the Incident

Section 5: Complainant's Certification

Typing your name and electronically sending this form to Mississippi State University Police Department constitutes your electronic signature and certifies that to the best of your knowledge the statements made herein are true, and you acknowledge that the making of false statements is punishable by criminal penalties.

Signature

Please provide first and last name

Date of Signature

If you have experience difficulty submitting this form, please contact MSU Police Department at 662.325.2121

Remain Anonymous

Would you like for any personal identifying information to be hidden upon submission of this complaint?

Section 2: Officer Information

Section 3: Medical Information

Section 4: Incident Information

Section 5: Complainant's Certification

Notice of Recording