Burlington Police Department Online Citizen Complaint Form

Citizen Information

Do you wish to remain anonymous?

Yes

If you choose to remain anonymous, we will not be able to follow up with you regarding your submission.

Would you be willing to meet in person to discuss this incident? *

Yes

Would you consider mediation as a way to resolve this incident? *

Yes

Name *

Address

Primary Contact Number *

Alternate Contact Phone Number

Email address

Date of Birth

Year

Month

Day

Age *

Gender *

Female

Male

Non-binary/third gender

Transgender

Prefer not to say

Prefer to self-describe

Describe *

Race/Ethnicity *

Asian/Pacific Islander

Black/African American

Hispanic/Latinx

Native American

White/Caucasian

Other

Other *

Incident Details

Incident Date *

Year

Month

Day

Approximate Time

Hour

Minute

Incident Location *

Enter the address or nearest intersection where the incident took place

Officer(s) Involved *

Enter the name(s) and/or badge number(s) of officer(s) involved. If unknown, enter physical description.

Complaint Category *

Select the category you feel best describes the alleged behavior.

Description of Incident *

Witnesses to Incident

Were there witnesses to the incident? *

Yes

Witness 1 Information

Witness 1 Name

Witness 1 Address

Witness 1 Phone Number

Witness 2 Information

Witness 2 Name

Witness 2 Address

Witness 2 Phone Number

Witness 3 Information

Witness 3 Name

Witness 3 Address

Witness 3 Phone Number

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Contact BPD

Burlington Police Department
Antonio B. Pomerleau Building
One North Avenue
Burlington, VT 05401

Phone: 802-658-2704

Emergency: Dial 911

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Burlington Police Department - Antonio B. Pomerleau Building - One North Avenue - Burlington, VT 05401 - (802) 658-2704
Emergency Call 911

THECITY
OFBURLINGTON

City Hall
149 Church Street
Burlington, VT 05401
Hours: M-F 8am-4:30pm

(802) 865-7000

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