EmailMe Form - Campus Security Authority Report Form

Enter your information below in case we need to contact you during our investigation.

Name *

First Last

Phone *

### - ### - ####

Email *

Witness Name

First Last

Witness Phone Number

### - ### - ####

Witness Email

Please provide as many details as possible about the incident.

Date the Incident was Reported *

MM / DD / YYYY

Date and Time the Incident Occurred

MM / DD / YYYY HH : MM AM/PM

Location of Incident

Please be as exact as possible (for example, west door of the library building).

Incident Description

Please include as much information as possible.

Victim / Suspect Relationship

Which category best fits the description of the incident?

Do you believe this incident was motivated by bias?

Yes

No

If you believe this incident was motivated by bias, please describe your reasons.