Campus Police

Online Crime Incident Report Form

This should be completed by those individuals identified as “campus security authorities” who are required to report information they receive about specified crimes (described below) pursuant to the federal Clery Act. The information collected from these forms will be used to prepare a compilation of statistical crime information that will be included in the campus’ annual security report. For more information about campus security authority responsibilities and the crime reporting process, please view the PowerPoint presentation.

The North Dakota State College of Science urges all crime victims and witnesses to report criminal acts to the police, and to report College policy violations or student conduct violations to Student Life at (701) 671-2224 or Campus Police at (701) 671-2233. However, if a reporting person requests anonymity, this request must be honored to the extent permitted by law. Accordingly, no information should be included on this form that would personally identify the victim without his/her consent.

Campus Police will use the information submitted to determine the appropriate category for the crime according to the requirements of the Clery Act.

Campus Security Authority name:
Signature of Campus Security Authority:
Phone number:
I have no crime to report for calendar year 2007: (Please check here , if you have no crime to report.)

I have received reports of crime(s) for calendar year 2007:

You need to submit a seperate Crime Incident Report Form for each of these crimes.
Crime Reported by:

If third party, please identify relationship to victim:

Date and time the incident occurred:

Description of the incident or crime:		Give as much details as possible.


Location of Incident

Identify building name, address, etc:		Be as specific as possible.


Location where this incident occurred was:
	On-campus, but not in student housing.
	On-campus student housing.
	Branch campus (ex. STTC).
	Off-campus affiliated property.
	(owned, controlled or affiliated with the campus; e.g., lease property, student Co-op, any area used for a college purpose)
	Off-campus public property immediately adjacent to campus.
	Off-campus, Not affiliated with or not adjacent to campus.
	Unkown.

Sex Offenses
Examples of sex offenses are rape, sodomy, sexual assault with an object, fondling, incest and statutory rape.
Was this a sexual offense?
Was the crime committed forcibly and /or against the victim's will?

Was the victim incapable of giving consent because of his/her youth or because of his/her temporary or permanent mental or physical incapacity?

If yes, were either the victim or the assailant under the influenced of alcohol or drugs?
Victim:
Assailant:

Hate Crimes
Hate crime information is required to be reported for each of the following crimes (criminal homicide, sex offense, robbery, aggravated assault, burglary, motor vehicle theft, and arson) and for any other crime involving bodily injury.

Is there evidence that this incident was motivated by hate or bias?

If yes, identify the category of prejudice, (Select all that apply):
(CTRL to select multiple choices.)

If yes, provide a brief explanation of the determination:


Alcohol, Drug and Weapons Law Violations
(Select all that apply):
(CTRL to select multiple choices.)

Describe:


Number of individuals arrested or referred for campus disciplinary action:

Select all that apply:
(CTRL to select multiple choices.)

Describe: