Submit a complaint

Required fields are marked with asterisks (*)

This form will submit directly to the Director of the University of Waterloo's Special Constable Service.

You will be advised, in writing, of the outcome of the investigation into your complaint.

Information and privacy: questions regarding the collection of information on this form can be directed to the form administrator.

Your personal information

First name * (required)

Last name * (required)

Date of birth * (required)

Year

Month

Day

Address

Postal Code/ZIP(+4) code * (required)

Country * (required)

Address * (required)

Address line 2

City * (required)

Province/State

Phone number * (required)

I would like correspondence sent to me via * (required)

Mail

Email * (required)

Incident date * (required)

Year

Month

Day

Incident time * (required)

Hour

Minute

Summary of incident * (required)

First name

Last name

Badge number

Description and additional information

List the first and last names of witnesses

Leave this field blank

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