University Police

Clery Report Form

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NOTE: If you need IMMEDIATE ASSISTANCE call the University Police directly at 911 from any campus phone or (518) 442-3131. This form generates a report that is normally reviewed during business hours and should not be used if you need an immediate response
 

Campus Security Authority Incident Report Form (Clery Act Reporting)
Who Should Use This Form?

The form below should be used by Campus Security Authorities to report crimes under the Clery Act that they have knowledge of but were not formally reported or investigated by the Police Department. This is an anonymous form that allows the Police Department more accurately track the number of crimes that are actually occurring for Clery reporting purposes. It is important to the members of University of North Alabama Police Department that the crime statistic information that it provides to the public is as clear and as accurate as it possibly can be

The following crimes should be reported using this form:

  • Murder/Non-Negligent Manslaughter – The willful killing of one human being by another.

  • Negligent Manslaughter – The killing of another person through gross negligence.

  • Forcible Sex Offense – Any sexual act directed against another person forcibly and/or against that person’s will; or not forcibly or against the person’s will where the victim is incapable of giving consent.

  • Non-Forcible Sex Offense – Unlawful, non-forcible sexual intercourse.

  • Robbery – Taking or attempting to take anything of value from the care, custody or control of a person or persons by force or threat of violence and/or by putting the victim in fear.

  • Aggravated Assault – Unlawful attack by one person upon another for the purpose of inflicting severe or aggravated bodily injury. Usually accompanied by the use of a weapon or by means likely to produce death or great bodily harm.

  • Burglary – Unlawful entry of a structure to commit a felony or a theft.

  • Motor Vehicle Theft – The theft or attempted theft of a motor vehicle. There are three classes of motor vehicle (1) autos, (2) trucks and buses, (3) and other vehicles.

  • Arson – Willful or malicious burning or attempt to burn with or without intent to defraud a dwelling house, public building, motor vehicle or aircraft, or the personal property of another.

  • Relationship/Dating Violence - Conduct arising out of a personal, intimate relationship that: (a) Inflicts physical injury upon another person; or (b) Places another in fear of, or at risk of, physical injury or danger.

  • Stalking:

    • (a) Engaging in a course of conduct directed at a specific person without the legal purpose and the individual engaging in that conduct knows or should know that the course of conduct would case a person to:

      • (i) Fear for the persons safety or the safety of the person's immediate family or close friends; or

      • (ii) Suffer substantial emotional distress.

  • Hate Crime – Any of the above offenses (in addition to damage to property, larceny, simple assault, and intimidation) that manifest evidence that the victim was intentionally selected because of the perpetrator’s bias or perpetrator perceived the person to be in one of the protected group categories. 

In all cases the person reporting the incident to the Campus Security Authority may choose to withhold their identity.


Do you know what offense may have been committed?

See the Handbook for Campus Crime Reporting for a full description of these offense categories - starting on page 23. Remember you are documenting your good faith estimate of what offense was reported to you. Law enforcement representatives will review the information given and make an official determination as to whether the elements of a particular offense are present. As always, "when in doubt report it out".)


What type of crime or incident has occurred or is going to occur?


Enter the date of the incident:

(mm/dd/yyyy)

Enter the time of incident:

(hh:mm am/pm)


General Location of Incident

(The basic definitions of the locations may be found below)

In Residence Hall

Yes   No Unknown
"In Residence Hall" is a sub-set of the "On Campus" category (below). If an incident is reported as having occurred within a residence hall note it in the "In Residence Hall" location rather than in the "On Campus" category below.

On Campus

Yes   No Unknown
Any building or property owned or controlled by an institution within the same reasonably contiguous geographic area and used by the institution in direct support of, or in a manner related to, the institution's educational purposes, including residence halls; and Any building or property that is within or reasonably contiguous to paragraph (1) of this definition, that is owned by the institution but controlled by another person, is frequently used by students, and supports institutional purposes (such as a food or other retail vendor).

Non-Campus

Yes   No Unknown
Any building or property owned or controlled by a student organization that is officially recognized by the institution; or Any building or property owned or controlled by an institution that is used in direct support of, or in relation to, the institution's educational purposes, is frequently used by students, and is not within the same reasonably contiguous geographic area of the institution.
 

Public Property

Yes   No Unknown
All public property, including thoroughfares, streets, sidewalks, and parking facilities, that is within the campus, or immediately adjacent to and accessible from the campus.


Describe what was reported to you

  • What occurred,

  • Were there any injuries,

  • Specific location (name of the residential hall, podium building, etc.),

  • Were police/campus officials involved,

  • Etc.

  • DO NOT include identifying information (name, room number, etc.) unless the victim requests that you do so.


Was this incident Hate or Bias related?
(If yes please indicate type of bias):

(See the Handbook for Campus Crime Reporting for more information on Hate Crimes reporting requirements under the Act.)

Yes No Unknown


Race
Gender
Religion
Sexual orientation
 

Ethnicity
Disability
Gender Identity
National Origin
Other

 


Please give us any other information that you feel is pertinent
(past incidents, other actions taken on your part to assist the victim, etc..)


The Information Below is for the Campus Security Authority, this information is voluntary.

 

Date Reported to CSA:

Time Reported to CSA:

Name of Reporting CSA:

Street Address:

Address (cont.):

City:

State/Province:

Zip/Postal Code:

Work Phone:

E-mail


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