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Clery Act
Report
Campus Security Authority Report
Campus Security Authority Report
Date of Report
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Month
Day
Year
Is the date of the incident known?
(Required)
Yes
No
Date of incident
(Required)
Month
Day
Year
Reported by
(Required)
Victim
Third Party
Name
(Required)
First
Last
Email Address of the Reporting Party
(Required)
Was law enforcement notified?
(Required)
Yes
No
Name of law enforcement agency
(Required)
Location of incident (building, office or room number, if known)
(Required)
Time of incident (if known)
Hours
:
Minutes
AM
PM
AM/PM
Incident Description
(Required)
Using the checkboxes below, select the crime(s) being reported. See
Crime Definitions
for descriptions of crimes.
Crimes
(Required)
Murder/Manslaughter
Aggravated Assault
Rape
Fondling
Incest
Statutory Rape
Burglary
Robbery
Motor Vehicle Theft
Arson
Dating Violence
Domestic Violence
Stalking
Hate Crime
Hazing
Liquor Law Violation
Drug Law Violation
Weapons Law Violation
Is there any evidence the crime was motivated by bias?
(Required)
Yes
No
Using the checkboxes below, select the best description(s) of the locations of the crimes being reported. See
Geographic Definitions
for descriptions of locations. If the crime occurred in multiple places, check all that apply.
What best describes the location of the crime?
(Required)
On Campus
On Campus - Residence Halls
Public Property immediately adjacent to Campus
Non-Campus
Unknown Location
I'm not sure
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