CSA Crime Reporting Form - A

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 - 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

Part II - C

Other Reports

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.)

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.

Part IV - B

Type of Crime (Crimes described below)

Part V

Incident Description