Campus Security Authority Crime & Incident Report Form

Please use this form if you are an individual identified as a "Campus Security Authority" to report the required information about specified crimes (listed below) pursuant to the federal Clery Act. The information collected from these forms is used to prepare a compilation of statistical crime information for inclusion in the campus' Annual Security and Fire Safety Report.

Completed forms will be forwarded to Brian Cadwell, Public Safety and Police Services Director and Chief.

For the following crimes, please indicate how many persons arrested/referred for each category. Please indicate if the same person was arrested/referred for multiple crimes.

Hate Crime Information
Hate Crime information must be reported for each of the following crimes: criminal homicide, sex offenses, robbery, aggravated assault, simple assault, burglary, larceny theft, motor vehicle theft, vandalism, intimidation and arson and for any other crime involving bodily injury.


It is the policy of the Department of Public Safety and Police Services to ensure that the victims and witnesses to crime are aware of their right to report criminal acts to the police and to report University policy violations to the appropriate office (e.g. student conduct violations to the Dean of Students). However, if a reporting person requests anonymity, this request must be honored to the extent permitted by law. Accordingly, no information should be included on this form that would personally identify the victim without his/her consent.

Based on information received, DPSPS will determine the category of the crime or incident and the location under which the incident should be reported in the Annual Security and Fire Safety Report.

Emergency Numbers