CSA Reporting Form

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Your Name

Your Title

Phone Number

Have you learned of a Clery Act crime that has not previously been reported to ��ֱ��PD, OSC, or the OIEC?

��Yes

��No

If "no," click the "No" box and submit this form. If "yes," continue.

When was the crime reported to you?

Clery Crime Committed?

��Yes

��No

Did you witness or receive a report of any of the criminal offenses listed below? Criminal homicide, murder and non-negligent manslaughter, manslaughter by negligence, rape, fondling, incest, statutory rape, robbery, aggravated assault, burglary, motor vehicle theft, arson

VAWA Crime Committed?

��Yes

��No

Did you witness or receive a report of any of the VAWA offenses? These include: dating violence, domestic violence, or stalking.

Hate Crime Committed?

��Yes

��No

Did you witness or receive a report of any hate crimes? For Clery reporting purposes, a hate crime includes: any of the criminal offenses listed above; or any of the VAWA offenses listed above; or larceny, simple assault, vandalism, or intimidation; or any other crime causing bodily injury. When the perpetrator was motivated by the victim’s actual or perceived: race, religion, gender, gender identity, sexual orientation, ethnicity, national origin, or disability.

Campus disciplinary action taken?

��Yes

��No

Did you witness or receive a report of arrests or referrals for campus disciplinary action for any of the following offenses: violation of local weapon laws, violation of local drug laws, or violation of liquor laws?

Reporting Method

��Yes

��No

Was this crime previously reported to ��ֱ��PD Dispatch (303-492-6666), the Office of Student Conduct (including through normal Residence Life reporting channels), or the Office of Institutional Equity and Compliance?

Crime Location

When did the incident occur?

Please offer a brief description of the crime

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CSA Reporting Form

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