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Give a Compliment

2. 

4. Name

5. Email Address

7. Address

9. City

10. State

11. Zip Code

13. Phone Number

14. Date of Birth (Optional)

15. Gender (Optional)
    -- Select One --MaleFemale

17. Race (Optional)
    -- Select One --American Indian or Alaskan NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderHispanic or LatinoWhite

18. Are you submitting this form on behalf of another person?

    1. Yes

    1. No

22. Date of Incident*
    Date of Incident

23. Time of Incident*
    Time of Incident

25. Location of Incident*

27. GJPD Incident Number (Optional)

28. Name or Badge Number of Involved GJPD Personnel

30. Please summarize your experience.*

32. If you have video or photos, please upload them here.

34. Would you like someone to contact you about this incident?

    1. Yes

    1. No

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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

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