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* Mandatory

Complainant Information
Complaint Type
Agency/Organization
SalutationLast *First *
Name
MiddleSuffix
Current Address *
Unit
City *
State *
Country
Zip Code *
Former Address
Unit
City
State
Country
Zip Code
Phone 1
Phone 2
Email *
Confirm Email *
Month *Day *Year *
Date of Birth
Social Security Number *
SalutationLastFirstMiddleSuffix
Names Previously Used
SalutationLastFirstMiddleSuffix
SalutationLastFirstMiddleSuffix
Attach Files
1. PLEASE ATTACH ANY DOCUMENTATION OR CORRESPONDENCE YOU MAY HAVE TO SUPPORT YOUR COMPLAINT
2. PLEASE ATTACH A LEGIBLE COPY OF GOVERNMENT-ISSUED, PHOTO IDENTIFICATION
(You must save the attachment after selecting each document if you want to attach multiple files. Click on the "Browse" button to select files. )


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Please retain a copy of this complaint for your records by clicking on the "Print" button below.
Please note you will not be able to print this complaint once it has been submitted to DCJIS.
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Please submit your complaint by clicking on the "Submit" button below.
If you do not submit your complaint at this time, the details will not be saved.



By electronically submitting my complaint, I attest under the penalties of perjury, that the information provided in this complaint, and in support thereof, is true to the best of my knowledge.
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