2. Type of Submission*

   1. Compliment
   2. Complaint
4. The Chevy Chase Village Police Department is committed to providing courteous, professional, bias-free service to all persons. We are also committed to integrity, respecting human rights and dignity, and to the tenets of constitutional policing. We value our relationship with the larger community, and we welcome your complaints or compliments about our employees or our policies.
6. COMPLAINTS ALLEGING EXCESSIVE FORCE MUST BE SIGNED AND SWORN TO UNDER PENALTY OF PERJURY.
8. You will be contacted upon receipt of the Compliment/Complaint Form
10. First Name
11. Last Name
13. Date of Birth
14. Gender
15. Race
    -- Select One --CaucasianAfrican AmericanAsianHispanicOther
17. Email Address
19. Address
21. City
22. State
23. Zip Code
25. Home Phone Number
26. Cell Phone Number
30. Location or address where the incident occurred*
32. Date and Time the incident occurred
    Date and Time the incident occurred

    Date and Time the incident occurred
33. Incident# (if known)
37. Witness Name
38. Phone Number
40. Address
42. City
43. State
44. Zip Code
48. Witness Name
49. Phone Number
51. Address
53. City
54. State
55. Zip Code
59. Name(s) of employee(s) involved
61. Describe what happened*
65. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
67. Electronic Signature
68. Date of submission
    Date of submission
72. FOR OFFICE USE ONLY
74. Date and Time Received
    Date and Time Received

    Date and Time Received
75. Initials and ID#
Leave This Blank:


79. 1. Receive an email copy of this form.
80. Email address

    This field is not part of the form submission.

81. Submit Submit and Print

* indicates a required field