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Bentley University Police Department Civilian Complaint Report

Please fill out the form below to submit a complaint report. You may also download the form here and mail it to: Chief Ernest H. Leffler, Callahan Police Station, 175 Forest St. Waltham, MA 02452 or email it to

Incident Information
Complainant Information
Employer Information
Assisting Complainants
Name or physical description, Badge #, Car #, etc.
Witness Information
Please Provide Answers to the Following Questions
To your knowledge, was all or any part of the incident complained of video or audio taped by anyone?
Are you afraid for your safety, or that of any other person, for any reason as a result of making this complaint?
Has anyone threatened you or otherwise tried to intimidate you in an effort to prevent you from making this complaint?
Are you able to read, write and speak the English Language?
If your answer to the question above is “No” or “Unsure”, have you been provided with adequate language assistance to help you understand and fill out this form?
Please provide a full description of the circumstances that prompted your complaint. Attach supporting documentation, as appropriate; including letters, e‐mails, photographs, videos or audio tapes, etc in the file upload segment below.

I have read, or had read to me, the above and attached complaint and statement. All of the answers are true and accurate to my knowledge. I understand that making a false statement/report could result in being held criminally and/or civilly liable for knowingly filing a false complaint or making a false statement