Report a Community Concern

Report a Community Concern Form

This form is for all residents of the City of Fremont, Ohio. Use this form to report incidents of discrimination and harassment. Please fill out the form below providing as much information as possible based on your knowledge of the situation. Please note that providing contact information is optional. If you choose not to provide your contact information, the form will be submitted anonymously.

Filing this concern is for resolution through the Mayor’s Community Relations Commission (CRC), and does not constitute filing an official police report or citizen complaint form with the Fremont Police Department. Nor does it supersede the policy and procedure of an organization, business, civic group, etc. within City Limits. This report is NOT confidential.

Report a Community Concern Form

Reporting Citizen’s Contact Information (Citizen filing complaint)

Date

Contact Name

Contact Email

Contact Phone

Contact Address

What is Your Preferred Language?

English

Spanish

Do You Need an Interpreter?

Yes

No

Relationship to Party Two

Cause of Discrimination

Please describe the reason(s) you are reporting a concern. Please be specific and includes as many details as possible(i.e. date, time, location, etc.)..

What action and/or intended outcome are you hoping for?

Party Two Contact Information (Citizen you have a complaint against)

Party Two Name

Party Two Email

Party Two Phone

Party Two Address

Relationship to Party One

Attestation

I hereby attest that I

affirm and certify that all the information and answers to questions herein are complete, true, and correct to the best of my knowledge and belief.

I hereby attest that I

understand that any misrepresentation, falsification, or omission of any facts in the report may render the report void anytime during the process.

Signature

Clear

If you are human, leave this field blank.

You will be contacted by a member of the Mayor’s Community Relations Commission to follow-up with any questions. If you do not hear back from a CRC member within two weeks after you have submitted your application, please call our office at 419-334-5900. Thank you for using the City of Fremont’s Report a Concern services presented by the Community Relations Commission. We look forward to assisting you and others in finding an acceptable resolution.

Residents