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Victim Advocate & Ombuds Clery Report Form


CLERY ACT REPORT FORM FOR CONFIDENTIAL RESOURCES
This form is to be used by UHS Victim Advocates and UW-Madison Ombuds. The purpose of this form is to compile statistics for the Annual Security Report. The statistics received from this report will be compiled in aggregate. Statistics received from this report will be included in the Daily Crime Log and will not be evaluated for a crime warning. If you believe the report you received poses an imminent threat to campus or a person's physical safety, please call UWPD at 608-264-2677.

If you are attempting to file a crime report as a Campus Security Authority (Clery) or as a Responsible Employee (Title IX) with more details, please click here. As a reminder, CSA and Responsible Employee reports may result in an official investigation or response from UW-Madison

For information regarding Wisconsin's sexual assault reporting responsibilities for employees (WI § 36.11(22)(c)) click here.

Definitions of sexual assault as defined by WI § 940.225.

Emotional, medical, legal, and campus support for victims/complainants is available online at: www.uhs.wisc.edu/assault.

Background Information

Questions

If a sexual offense occurred check all that apply: (Definitions listed above.)(Required)
You must make at least one selection.
Is or was there an intimate relationship between the victim and the offender?(Required)
You must make at least one selection.
Has the victim/complainant had contact with other agencies? (Check all that apply.)(Required)
You must make at least one selection.
This field is required.
Crime(Required)
You must make at least one selection.
If the offense appears to be motivated in whole or in part by the offender's bias against a protected class of people, select the class below. If none or no known bias, select the last option. (If not one of the following classes, it is not considered a hate crime for Clery Act reporting purposes.)(Required)
You must make at least one selection.
Location of Incident
This field is required.

Submission