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2. CONTACT INFORMATION:

   Note:  If you wish to submit this information to the City Manager anonymously, please leave the "Contact Information" section blank.

4. First Name
5. Last Name
7. Phone:
8. Email
10. Address1
12. Address2
14. City
15. State
16. Zip
18. Date of Birth
20. Do you wish for the contact information provided above to be kept confidential by the City Manager?

    1. Yes

    1. No

    NOTE:  The City is committed to your anonymity, however, there are some situations that may require the release of information when related to The Wyoming Public Records Act.

22. Which of the following demographic groups do you identify with? SELECT ALL THAT APPLY

    1. Black or African American
    2. Asian
    3. Hispanic, Latino/a/s, or Spanish Orgin
    4. Immigrant
    5. LGBTQ+
    6. Native American or Alaskan Native
    7. Native Hawaiian or Other Pacific Islander
    8. White

    1. Person with Disabilities
    2. Veteran
    3. Female
    4. Male
    5. None of the Above
    6. Prefer Not to Answer
    7. Prefer to Self-Describe _____________________________
    8. Other ___________________________
24. ABOUT THE INCIDENT: Please provide details about the incident(s) to the best of your ability.
26. Date and Time of Incident(s):
28. Approximate Date and Time of Incident(s):
30. Location of Incident(s):
32. Have you contacted your elected representation about this matter?

    1. Yes

    1. No
34. Have you contacted other City leadership or staff members about this matter?

    1. Yes

    1. No
36. DETAILS: Please provide a summary of the incident(s) with as much detail as possible, such as name of employee(s), department, vehicle type or license plate, badge number, etc.
38. Police Report Number (if applicable):
40. Citation Number (if applicable):
42. OTHER INFORMATION: If you know of anyone who witnessed the incident(s), please provide their name(s) and contact information.
44. After submitting any additional files you may have, please come back to this form and click on the "Submit" button below to send your complaint to us.

    Upload only PDF or Word documents. Photos (jpg), but not videos can be uploaded. Also, please limit the size of your files.

46. File 1
47. File 2
48. File 3
49. File 4
51. ATTEST

    1. Agree
    2. Disagree

    I attest that all information provided is complete and accurate to the best of my knowledge. Additional files may be submitted later on during the process.

Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field