Crime and Fire Statistic Reporting Form
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Today's Date *
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Your Contact Information (Person/CSA Submitting Form)
Your Name: *
Your Email: *
Your Phone Number: *
Date Incident Occurred:
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Time Incident Occurred:
Time
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Was the incident reported to Southeastern Louisiana University Police Department or other local law enforcement?
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Does the victim want the incident reported to law enforcement?
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Victim's Contact Information:
The below information is based on the VICTIM who reported the incident to you.
Reported by: *
First Name (optional):
Last Name (optional):
Phone Number (optional):
Email Address (optional):
If a third party reported the crime to you, please enter the relationship of the third party to the victim:
Incident Information:
The below information is related to the details of the reported incident.
What best describes the location of the crime? (If the crime occurred in multiple places, check all that apply.)
Incident Description (Please provide specific, detailed information):
Please select offense that occurred:
As of January 1, 2025, the crime of Hazing has been added to the list of Clery reportable Crimes.

The term “hazing”, for purposes of reporting statistics on hazing incidents means; any intentional, knowing, or reckless act committed by a person (whether individually or in concert with other persons), against another person or persons regardless of the willingness of such other person or persons to participate, that-
- is committed in the course of an initiation into, an affiliation with, or the maintenance of membership in, a student organization; and
- causes or creates a risk, above the reasonable risk encountered in the course of participation in the institution of higher education or
the organization (such as the physical preparation necessary for participation in an athletic team), of physical or psychological injury
including:

- whipping, beating, striking, electronic shocking, placing of a harmful substance on someone’s body, or similar activity;
-  causing, coercing, or otherwise inducing sleep deprivation, exposure to the elements, confinement in a small space, extreme calisthenics, or other similar activity;
- causing coercing, or otherwise inducing another person to perform sexual acts;
- any activity that places another person in reasonable fear of bodily harm through the use of threatening words or conduct;
- any activity against another person that includes a criminal violation of local, State, Tribal or Federal law; and 
- any activity that induces, causes, or requires another person to perform a duty or task that involves a criminal violation of local, State, Tribal, or Federal law.

Have you received a report of hazing as defined above?
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NOTE: The following crimes are only required to be reported if the crime was motivated by bias (hate crime).
Is there any evidence that this crime was  motivated by bias?
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If yes, please choose any/all categories of bias that apply.
If you answered yes to the "Motivated by Bias" question, please provide a brief summary of the evidence supporting a bias motivation.
A copy of your responses will be emailed to the address you provided.
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