GEORGETOWN UNIVERSITY POLICE DEPARTMENT (GUPD) CAMPUS SECURITY AUTHORITY (CSA) CRIME REPORT FORM
Section A: Introduction
This Report Form is only to be used by CSAs to report Clery Act incidents. Note: if the CSA can verify that University Police responded and took a police report, then it is not necessary for the CSA to complete and submit this form. All others should contact GUPD directly to file a Police Report. In an emergency, call (202) 687-4343 if you are on campus, or 911 if you’re off campus. CSAs filing reports will receive an email providing the Georgetown University Police Department (GUPD) CSA Crime Report case number associated with their reported incident.

What is a CSA?
Campus Security Authorities (CSA) are federally mandated crime reporters. They are officials with significant responsibility for student and campus activities. CSAs shall report, in a timely manner, any Clery Act crimes that they are made aware of to GUPD, who will use the information that CSAs submit to classify the crime properly. It is therefore imperative that CSAs document the crime with sufficient detail. CSAs should not actively investigate crimes, however.
Just who are CSAs? They include, but are not limited to: University Police – Title IX Coordinators – RA’s – Student Guards – Student Affairs – Student Affairs Vice Presidents – Athletics Director and Coaches – Faculty Advisor to Student Groups – Sexual Assault Response Team (SART) – Health Center Counselor - Ombudsperson - Peer Counselors, etc.
Submission – To send the completed report form electronically, please click on the submit button at bottom of this form. You may also print this form and either fax (202-687-8160) or campus mail to the Georgetown University Police Department, Village C West, Attention Clery Act Review Team, who will review and take appropriate action on all CSA reports submitted to them.

Date crime reported to CSA *
MM
/
DD
/
YYYY
Crime Occurence *
Crime Occurrence Date *
MM
/
DD
/
YYYY
Crime Occurrence Location *
Please provide building name, address, street name with cross streets or close address, or nearby buildings if it occurred outside.
Your answer
GU CAMPUS *
Select campus associated with incident
Classification *
Required
Reported Crime *
Check the box that best indicates the crime you are reporting.
Required
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