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.

CSA Name
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.

Reporting Party Name

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:
Part V

Part V

Incident Description