POLICE BRUTALITY INTAKE FORM
The National Bar Association has established a process that will allow members of the task force to evaluate complaints of police misconduct and/or police brutality. Individuals will be required to complete a Police Brutality Intake Form, giving a brief description of the case and other pertinent information. This information will be inputted into the system for further review and a determination will be made whether the National Bar Association will launch an investigation and/or take any action on behalf of the complainant.
*Obligatoire
First Name
*
Votre réponse
Last Name
*
Votre réponse
Phone Number
*
(123) 456-7890
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Email Address
*
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For Attorneys ONLY
(Answer if you are an attorney filing a complaint)
Yes, I am a National Bar Association Member
No, I am not a National Bar Association Member
If you answered yes to the above, provide your National Bar Association affiliate chapter:
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Name of Police Department
*
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First Name
*
Police Officer (If you do not have this information, type "First Name Missing")
Votre réponse
Last Name
*
Police Officer (If you do not have this information, please type, "Last Name Missing")
Votre réponse
Badge Number
*
Police Officer (If you do not have this information, please type, "Badge Number Missing")
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Brief Description of Incident
*
Include specifics on when, where and how the incident occurred.
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Injuries/Damages Suffered During the Incident
*
Include specifics on when, where and how the incident occurred.
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Previous Incidents by Police Officer or Police Department
*
Include specifics on when, where and how the incident occurred.
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Documented Evidence of Alleged Brutality
Videos (Below, include the following: how many, who recorded it, etc.)
Audiotape Recordings (Below, include the following: how many, who recorded it, etc.)
Witnesses (Below, include, name/contact information):
Other (Describe this information below)
None ( You do not have any evidence.)
If the above was selected, please provide additional information as indicated.
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News Stories/Articles about Incident
Include specifics on when and who aired the story/article.
Votre réponse
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