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Clery Reporting Form


IMPORTANT NOTE: This form is not confidential and will be sent directly to Campus Police.

If you observe any crime listed below, or if any person reveals to you that he/she learned of or was a victim of, perpetrator of, or witness to any crime listed below, immediately complete this form. Incidents must be reported to Campus Police as they occur.

If you have any questions regarding completing this form you can contact Campus Police 24 hours a day, 365 days a year, at 508-767-7225.

Please provide your name, department, and phone number and complete all sections below.

Reporter Information

 
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Involved Parties

If reporting a Sexual Offense DO NOT INCLUDE THE NAME OF THE VICTIM/SURVIVOR

Involved party 1

CRIMES

 Please read the following definitions of reportable crimes and click all that apply in question 1

 



Criminal Homicide - Murder, non-negligent manslaughter, and negligent manslaughter

 



Sex Offenses -
      (a) Forcible Sex Offenses (Includes Rape, Sodomy, sexual fondling, sexual assault with object)
      (b) Non-Forcible Sex Offenses (Statutory rape or incest)

      If you are reporting a Sexual Offense you must complete the Sex Offense Reporting Form.

 



Robbery - Taking/Attempting to take something by force, violence, threat, or by putting victim in fear

 



Aggravated Assault - Unlawful attack upon another with intent to inflict severe injury or great bodily harm.

 



Burglary - Unlawful entry into a structure to commit a felony or theft.

 



Motor Vehicle Theft - Theft of automobiles, trucks, etc. including "joy riding"

 



Arson - Willful or malicious burning/attempt to burn a structure, vehicle or personal property of another.

 



Illegal Weapon Possession

 



Dating Violence - means “violence committed by a person:

         - who is or has been in a social relationship of a romantic or intimate nature with the victim; and

 

         - where the existence of such a relationship shall be determined based on a consideration of the following factors:

 

              o the length of the relationship;

 

              o the type of relationship; and

 

              o the frequency of interaction between the persons involved in the relationship.”

 

 



Domestic Violence -means a “felony or misdemeanor crime of violence committed by:

            - a current or former spouse or intimate partner of the victim,

 

              - a person with whom the victim shares a child in common,

 

                - a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner,

 

                  - a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction



                      receiving grant monies [under VAWA], or

 

                    - any other person against an adult or youth victim who is protected from that person’s acts under the domestic or



                        family violence laws of the jurisdiction.”

 

 



Stalking

              - means “engaging in a course of conduct directed at a specific person that would cause a reasonable person to:

 

                      - fear for his or her safety or the safety of others; or

 

                        - suffer substantial emotional distress.”





1. Please Check all that apply(Required)
You must make at least one selection.
This field is required.
2. Is there evidence that this incident was motivated by hate or bias?(Required)
You must make at least one selection.
If you selected yes regarding the incident being motivated by hate or bias, Identify the potential category of prejudice. (check all that apply)
You must make at least one selection.
This field is required.
3. Did this crime occur in a building or on a street? (Identify location in Reporter Information Section above)(Required)
You must make at least one selection.
4. Did the crime occur on school owned, controlled, or leased property?(Required)
You must make at least one selection.
5. Did the crime occur at a College-sponsored activity or event?(Required)
You must make at least one selection.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission