Aquinas College Crime and Disciplinary Referral Report Form
In accordance with the Higher Education Act of 20 U.S.C 1092 now known as the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, Aquinas College must collect certain campus crime statistics.  This law applies to certain crimes reported to the Campus Safety Department and other campus officials.  The details of this report will not be made public.  Only the number of crimes occurring will be released.  Your name will not be released.  It is not required for the report, but will help ensure the crime is not counted twice.  Questions may be directed to the Campus Safety Office at (616) 632-2462
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Date of Crime *
When did this event occur?
MM
/
DD
/
YYYY
Time
:
Location of Incident
Please provide address or location (i.e. Regina Hall, Academic building etc.)
Classification of Incident Location. *
Please choose from the drop down list.
What Type of Crime occurred? *
Please choose from the drop down list.
Was this a Hate Crime
Clear selection
What was the Hate Crime based On?
If you answered yes to Hate Crime Please choose from the following;
Clear selection
Name of Reporting Person.
Incident Summary *
Please tell us what happened?
Reporting Person
Staff Use
Law Enforcement Notified?
Staff Use
Clear selection
Report Prepared by
Staff Use
Discipline Action Referred to
Staff Use
Clear selection
Submit
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