Campus Security Authority (CSA) Reporting Form

This form is used to report safety or security incidents at 51动漫 which ARE NOT of a sexual nature and do not potentially violate Title IX.聽 For Title IX issues, please use the Title IX Reporting Form.

"*" indicates required fields

Reporting Person Contact Information

Reported By:*

The Victim

A Third Party

If a third party reported the crime to you, please enter the relationship of the third party to the victim:*

Name*

First Last

Phone*

Email*

Agency Notified

If to your knowledge, a law enforcement agency was notified, please enter the name of that agency.

Agency:

Does the victim want the incident reported to law enforcement?

Yes

Incident Information

Location of the Incident*

Building Name/Room Number Street Address City State ZIP

Date of Incident*

MM slash DD slash YYYY

Time of Incident

(If Known)

Hours

Minutes

AM/PM

Incident Description*

Please provide specific, detailed information

Location

What best describes the location for the crime?*

(If the crime occurred in multiple places, check all that apply. Please see detailed description below.)

On campus, residence hall

On campus, not in a residence hall

Public property inmediately adjacent to cmapus

Non-campus in a University owned leased or controlled space (fraternity, sorority, off-campus classroom)

Unknown location/ Other

I do not know which category this would fall under.

Geography Definition: On campus
Any building or property owned or controlled by an institution within the same reasonably contiguous geographic area and used by the institution in direct support of, or in a manner related to, the institution鈥檚 educational purposes, including residence halls; and
Any building or property that is within or reasonably contiguous to the area identified in paragraph (1) of this definition, that is owned by the institution but controlled by another person, is frequently used by students, and supports institutional purposes (such as food or other retail vendors)

Geography Definition: Public Property
All public property, including thoroughfares, streets, sidewalks, and parking facilities, that is within the campus, or immediately adjacent to and accessible from the campus

Geography Definition: Non-campus building or property
Any building or property owned or controlled by a student organization that is officially recognized by the institution; or
Any building or property owned or controlled by an institution that is used in direct support of, or in relation to, the institution鈥檚 educational purposes, is frequently used by students, and is not within the same reasonably contiguous geographic area of the institution

Please describe location to the best of your abilities:*

Incident Category

(Select to see definitions of offenses below)

Homicide

Sex Offense

Aggravated Assault

Motor Vehicle Theft

Burglary

Robbery

Arson

Dating Violence

Domestic Violence

Stalking

Hate Crime

Arrest for Liquor Law Violation

Referral for Liquor Law Violation

Arrest for Weapons Law Violation

Referral for Weapons Law Violation

Arrest for Drug Law Violation

Referral for Drug Law Violation

I am not sure how to classify this incident

Other:

If the crime was not listed above, please enter the additional crime category:*

Homicide
Murder/non-negligent manslaughter: the willful (non-negligent) killing of one human being by another Negligent Manslaughter: the killing of another person through gross negligence

Sex Offense
Any sexual act directed against another person without the consent of the victim, including instances where the victim is incapable of giving consent
Rape: The penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim
Fondling: The touching of the private body parts of another person for the purpose of sexual gratification, without the consent of the victim, including instances where the victim is incapable of giving consent because of his/her age or because of his/her temporary or permanent mental incapacity
Incest: Sexual intercourse between persons who are related to each other within the degrees wherein marriage is prohibited by law
Statutory Rape: Sexual intercourse with a person who is under the statutory age of consent

Motor Vehicle Theft
The theft or attempted theft of a motor vehicle

Aggravated Assault
Unlawful attack by one person upon another for the purpose of inflicting severe or aggravated bodily injury.

Burglary
Unlawful entry of a structure to commit a felony or a theft

Robbery
Taking or attempting to take anything of value from the care, custody, or control of a person or persons by force or threat of force or violence and/or by putting the victim in fear

Arson
Willful or malicious burning or attempt to burn with or without intent to defraud a dwelling house, public building, motor vehicle or aircraft, personal property of another, etc.

Dating Violence
Violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim; and where the existence of such a relationship shall be determined based on a consideration of the following factors:
鈥he length of the relationship
鈥he type of the relationship
鈥he frequency of interaction between the persons involved in the relationship

Domestic Violence
Felony or misdemeanor crimes of violence committed by a current or former spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner, by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction鈥r by any other person against an adult or youth victim who is protected from that person鈥檚 acts under the domestic or family violence laws of the jurisdiction

Stalking
Stalking Engaging in a course of conduct directed at a specific person that would cause a reasonable person to fear for his or her safety or the safety of others, or suffer substantial emotional distress

Arrest for Liquor Law Violation
The violation of state or local laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, or use of alcoholic beverages

Referral for Liquor Law Violation
The violation of state or local laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, or use of alcoholic beverages

Arrest for Drug Law Violation
The violation of laws prohibiting the production, distribution and/or use of certain controlled substances and the equipment or devices utilized in their preparation and/or use

Referral for Drug Law Violation
The violation of laws prohibiting the production, distribution and/or use of certain controlled substances and the equipment or devices utilized in their preparation and/or use

Arrest for Weapons Law Violation
The violation of laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, concealment, or use of firearms, cutting instruments, explosives, incendiary devices, or other deadly weapons

Referral for Weapons Law Violation
The violation of laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, concealment, or use of firearms, cutting instruments, explosives, incendiary devices, or other deadly weapons

Is there any evidence that this crime was motivated by bias?*

Yes

If yes, please choose any/all categories of prejudice that apply.*

Race

Gender

Ethnicity

Religion

Disability

National Origin

Gender Identity

Sexual Orientation

Please provide a brief summary of the evidence supporting a bias motivation:*