CSA Crime Report Form

The federal Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, otherwise known as the Clery Act (Act), applies to certain crimes reported to the police and other College officials known as Campus Security Authorities (CSA). The Act defines CSA’s as mandated crime reporters. As such, CSA’s are required to report any Act qualifying crimes that they are made aware of to the Dartmouth College Safety and Security. Timely reporting of crimes is encouraged and sometimes required.

Safety and Security will use the submitted information to verify the appropriate crime classification and to compile statistics to be included in the Annual Security Reports that Dartmouth College publishes and distributes each fall. If a crime has recently occurred, or you need assistance with information on this form please notify the Dartmouth Department of Safety and Security right away at (603) 646-4000 to assist and additionally decide if a timely warning needs to be generated.

An * indicates a required field.

Contact Information

Victim/Survivor Information

Dates

Check the box that best indicates the crime you are reporting.
This form can be used to report any crime to the Dartmouth College Department of Safety and Security not required under the federal Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act. The college encourages reporting of all crimes to Safety and Security. The following crimes need only be reported if the victim(s) of the reported crime was/were targeted specifically because of bias/prejudice against the victim.
Were any of the above crimes motivated by bias (was the victim specifically targeted because of prejudice i.e. a Hate Crime)

Section F – 1

Section H: Secondary Reporting

Compliance

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