Community Trigger Form

Are you activating the trigger on behalf of someone else?*
- Yes
- No
Do you have their permission to do so?*
- Yes
- No
Why not?*
Community Trigger Reason
Please select if .....*
- You (as an individual) have complained three times in the last six months about separate incidents
- Five people in the local community have complained separately in the last six months about similar incidents
- You (as an individual) have complained in the last 6 months about an incident or crime motivated by hatred (hate crime)
Individual Complainant
Name*
First Last
Address*
Street Address City State Zip Code
Phone
Email
Age of complainant if under 18 years old
Referring on behalf of complainant
Their Name*
First Last
Their Address*
Street Address City State Zip Code
Their Telephone number
Your Name*
First Last
Your Telephone Number
Please state the reason you are referring on behalf of the complainant, for example, language barrier, vulnerability etc*

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Community Trigger Reason