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.
First Name *
Last Name *
Phone Number *
(123) 456-7890
Email Address *
For Attorneys ONLY
(Answer if you are an attorney filing a complaint)
If you answered yes to the above, provide your National Bar Association affiliate chapter:
Name of Police Department *
First Name *
Police Officer (If you do not have this information, type "First Name Missing")
Last Name *
Police Officer (If you do not have this information, please type, "Last Name Missing")
Badge Number *
Police Officer (If you do not have this information, please type, "Badge Number Missing")
Brief Description of Incident *
Include specifics on when, where and how the incident occurred.
Injuries/Damages Suffered During the Incident *
Include specifics on when, where and how the incident occurred.
Previous Incidents by Police Officer or Police Department *
Include specifics on when, where and how the incident occurred.
Documented Evidence of Alleged Brutality
If the above was selected, please provide additional information as indicated.
News Stories/Articles about Incident
Include specifics on when and who aired the story/article.
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