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Clery Crime Report Form


IF YOU NEED TO REPORT AN EMERGENCY OR CRIME IN PROGRESS, CALL THE WICHITA STATE UNIVERSITY POLICE AT 316-978-3450, or DIAL 911.

This form is to be utilized by individuals who have been designated by Wichita State University as a Campus Security Authority (CSA) under the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (Clery Act). Information requested in this form is necessary to compile campus crime statistics in accordance with the Clery Act.

As a CSA, you must provide as much of the requested information on this form as possible. If the person who disclosed a Clery crime to you requests confidentiality, you are not required to report that person’s identity, but you must report a description of the incident that is reported to you, the date of the incident, and the location of the incident. If the reporter suggests that the incident was based on the victim’s race, gender, sexual orientation, or other hate crime classification as noted below, evidence of that bias should be described in a short statement. All reports will be reviewed to determine the appropriate crime classification.

Completing this Report Form will NOT generate an official police report. If you need assistance with completing this form or filing an official police report, please contact WSUPD at 316-978-3450.

Background Information

 
Email address must be of a valid format.
This field is required.
This field is required.

Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. Do not provide name/contact information if the person reporting the incident requests confidentiality.

Involved party 1

Questions

How were you made aware of this incident?(Required)
You must make at least one selection.
Has this incident been reported to law enforcement?(Required)
This field is required.
This field is required.
This field is required.
This field is required.
Incident Category(Required)
You must make at least one selection.
Is there evidence that this crime was motivated by bias?(Required)
This field is required.
If yes, please select the indicated bias categories involved:
You must make at least one selection.
This field is required.

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