University Police Department
Campus Security Authority Reporting
University Police Department
This crime report form is in compliance with
20 USC § 1092
of the
Higher Education Act of 1965
. As required by
20 USC § 1092 (f)
of the
Higher Education Act of 1965
and
California Education Code § 67380
,
Campus Security Authorities (CSA) are required to report crimes that occur.
Date/Time of Incident
When you were notified of the incident?
Entry must have the following format: MM/DD/YYYY HR:MIN AM/PM (Example: 06/22/2019 07:05 PM)
x
When did the incident take place?
Entry must have the following format: MM/DD/YYYY HR:MIN AM/PM (Example: 06/22/2019 07:05 PM)
x
Contact Information
First name
Last name
Preferred email
Phone
Are you a CSA as defined by the Clery Act?
I am a CSA as defined by the Clery Act
I am not a CSA
Report Details
Where was this crime/incident reported to have occurred?
(be as specific as possible)
What was reported to you?
(tell us what the person told you)
Was the crime you are reporting a HATE crime?
Yes
No
If it was a HATE crime please share what you believe the bias was?
Disability
Ethnicity
Gender
Gender Identity
National Origin
Race
Religion
Sexual Orientation
Please enter the circumstances that made you believe this incident was motivated or carried out as a result of hate
Does this incident or event pose an on-going threat to the campus community?
Yes
No
Please describe why
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