The members of the Rapid City Police Department are committed to providing law enforcement services that are fair, effective and impartially applied. In order for us to effectively manage our department, we need to hear from those we serve. This form is provided for you to tell us about your positive contact with members of the Rapid City Police Department. Thank you for taking the time to let us know how we are serving Rapid City.

Personal Information Please provide your name, address and contact numbers or you can remain anonymous:
First Name
Last Name
Address	Street Address
	City State Zip
Email
Home Phone
Work/Cell Phone
Officer Information Please provide the following information to assist in the identification of the involved officer(s):
Officer's Name Badge ID# Vehicle # Other Desc. Officer's Name Badge ID# Vehicle # Other Desc. Additional Officers:
Incident Information Please provide details of the incident:
Date/Time Location
Description of Incident Would you like to contacted about this incident? Yes No
Type the characters you see in the picture below. Letters are not case-sensitive.
By submitting this form, I verify that the statements made are true.