Intake form

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Name *

Email address *

Type of public servant involved

Location of the incident or issue

Date of the incident or issue

Nature of the complaint

Please select at least one option.

Misconduct

Negligence

Corruption

Abuse of power

Discrimination

Have you reported this issue to any authorities?

If yes, please specify the authority or organization

Preferred method of contact

Phone number

Additional questions or comments

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