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2. Disclaimer
   Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.
4. What is Your Concern*
   -- Select One --Report a Cyber Security ConcernGeneral Jeffco Question

   This form is to report a cyber security concerns for Jefferson County.
6. Name*
7. Email Address*
9. Phone Number
11. Incident Description:*
13. Do you feel your concern is urgent?*

    If you select urgent (below) please provide accurate contact information above. If the Chief Security Information Officer deems the matter urgent, you will be contacted within three business day.

    1. Urgent

    1. Not Urgent
15. General Contact Information
    General County Contact Information

    If your question does not relate to Secure Jeffco or cyber security, please use our general contact us form.
Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field