Indicates required field
Part I

As part of the federal Clery Act, qualifying incidents reported to various sources, including Campus Security Authorities (CSA), are required to be published in an Annual Security Report and made available to the campus community each fall. One purpose of the Clery Act is to encourage the reporting and collection of accurate campus crime statistics to promote crime awareness and enhance campus safety.

Part I

Campus Security Authority contact information is mandatory, as we may need to follow-up with you.

Part II

Part II - A

Victim/Witness Information

If the victim or witness wishes to remain anonymous to police, please enter only the first and last initials of the reporting party. This will help us make comparisons to avoid double reporting. If you provide your full name and contact information, UIS Police will contact you.

Part II - B

Direct or Third Party Report

Was the crime reported to you by the victim or a third party/witness?
Please give the relationship to the victim

Part II - C

Other Reports

Was this crime reported to any law enforcement agency?
Please give the agency to which the crime was reported, prior to the report made to you.
Part III

Part III - A

Date Incident Reported to CSA

Complete this section if a reportable crime was reported to you. Complete it to the best of your ability. If more than one crime incident was reported to you, complete multiple forms.

Part III - B

Date of Incident Occurrence

If the Specific Date of Occurrence is unknown, please leave blank. Please enter Range of Dates instead.

Part III - C

Location of Incident Occurrence (This section MUST be completed.)

UIS On-Campus Location
(Please describe property directly adjacent to the UIS on or off-campus facilities listed in the questions above.)
Part IV

Part IV - A

Hate Crime

A Hate Crime is not a separate, distinct crime, but is the commission of a criminal offense which was motivated by the offender's bias. For example, a subject assaults a victim, which is a crime. If the facts indicate that the offender was motivated to commit the offense because of his bias against the victim's race, sexual orientation, etc., the assault is then also classified as a hate/bias crime.

Is this crime incident suspected to be a Hate Crime?
Hate Crime Category

Part IV - B

Type of Crime (Crimes described below)

Please choose the crime(s) that the victim/witness reported to you:
An unlawful attack by one person upon another for the purpose of inflicting severe or aggravated bodily injury. This type of assault usually is accompanied by the use of a weapon or by means likely to produce death or great bodily harm. (It is not necessary that injury result from an aggravated assault when a gun, knife or other weapon is used which could or probably would result in a serious potential injury if the crime were successfully completed.)
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.
An unlawful physical attack by one person upon another where neither the offender displays a weapon, nor the victim suffers obvious severe or aggravated bodily injury involving apparent broken bones, loss of teeth, possible internal injury, severe laceration or loss of consciousness.
Murder/Non-Negligent Manslaughter: the willful (non-negligent) killing of one human being by another. (NOTE: Do not include deaths caused by negligence, attempts to kill, assaults to kill, suicides, accidental deaths, or justifiable homicides.) Manslaughter by Negligence: the killing of another person through gross negligence.
Violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim.

(1) The existence of such a relationship shall be determined based on the reporting party's statement and with consideration of the length of the relationship, the type of relationship, and the frequency of interaction between the persons involved in the relationship.

(2) For the purpose of this definition - (i) Dating violence includes, but is not limited to, sexual or physical abuse or the threat of such abuse; or (ii) Dating violence does not include acts covered under the definition of domestic violence.
A felony or misdemeanor crime of violence committed - (i) By a current or former spouse or intimate partner of the victim; (ii) By a person with whom the victim shares a child in common; (iii) By a person who is cohabiting with or has cohabited with the victim as a spouse or intimate partner; (iv) By a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred; or (v) By any other person against an adult or youth victim who is protected from that person's acts under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred.
To unlawfully place another person in reasonable fear of bodily harm through the use of threatening words and/or other conduct, but without displaying a weapon or subjecting the victim to actual physical attack.
(1) Engaging in a course of conduct directed at a specific person that would cause a reasonable person to - (i) Fear for the person's safety or the safety of others; or (ii) Suffer substantial emotional distress.

(2) For the purpose of this definition - (i) Course of conduct means two or more acts, including, but not limited to, acts in which the stalker directly, indirectly, or through third parties, by any action, method, device, or means follows, monitors, observes, surveils, threatens, or communicates to or about, a person, or interferes with a person's property; (ii) Reasonable person means a reasonable person under similar circumstances and with similar identities to the victim; or (iii) Substantial emotional distress means significant mental suffering or anguish that may, but does not necessarily, require medical or other professional treatment or counseling.
Any willful or malicious burning or attempt to burn, with or without intent to defraud, a dwelling house, public building, motor vehicle or aircraft, or personal property of another, etc.
The unlawful entry of a structure to commit a felony or a theft. For reporting purposes this definition includes: unlawful entry with intent to commit a larceny or a felony; breaking and entering with intent to commit a larceny; housebreaking; safecracking; and all attempts to commit any of the aforementioned.
To willfully or maliciously destroy, damage, deface, or otherwise injure real or personal property without the consent of the owner or person having custody or control of it.
The unlawful taking, carrying, leading, or riding away of property from the possession or constructive possession of another. (Note: Include attempted larcenies. Do not include embezzlement, confidence games, forgery, worthless checks, etc.)
The theft or attempted theft of a motor vehicle. (Classify as motor vehicle theft all cases where automobiles are taken by persons not having lawful access, even though the vehicles are later abandoned - including joy riding)
The taking or attempting to take anything from value of 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.
Violations of state and local laws relating to the unlawful possession, sale, use, growing, manufacturing, and making of narcotic drugs. The relevant substances include: opium or cocaine and their derivatives (morphine, heroin, codeine); marijuana; synthetic narcotics (Demerol, methadones); and dangerous non-narcotic drugs (barbiturates, Benzedrine).
Violation of laws or ordinance prohibiting: the manufacture, sale, transporting, furnishing, possessing of intoxicating liquor; maintaining unlawful drinking places; bootlegging; operating a still; furnishing liquor to minor or intemperate person; using a vehicle for illegal transportation of liquor; drinking on a train or public conveyance; all attempts to commit any of the aforementioned. (Drunkenness and driving under the influence are not included in this definition.)
Violation of laws or ordinances dealing with weapon offenses, regulatory in nature, such as: manufacture, sale, or possession of deadly weapons; carrying deadly weapons, concealed or openly; furnishing deadly weapons to minors; aliens possessing deadly weapons; all attempts to commit any of the aforementioned.
Part V

Part V

Incident Description