Crime and Fire Statistic Reporting Form

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Email *

Today's Date *

YYYY

Your Contact Information (Person/CSA Submitting Form)

Your Name: *

Your Email: *

Your Phone Number: *

Date Incident Occurred:

YYYY

Time Incident Occurred:

Time

Was the incident reported to Southeastern Louisiana University Police Department or other local law enforcement?

Yes

Unknown

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Does the victim want the incident reported to law enforcement?

Yes

Unknown

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Victim's Contact Information:

The below information is based on the VICTIM who reported the incident to you.

Reported by: *

The Victim

Third Party

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.)

On campus, residence hall

On campus, not in a residence hall - Any building or property owned or controlled by an institution within the same reasonably contiguous geographic area and used by the institution in direct support of, or in a manner related to, the institution's educational purposes, including residence halls; and any building or property that is within or reasonably contiguous to the area that is owned by the institution but controlled by another person, is frequently used by student, and supports institutional purposes (such as food or other retail vendors).

Public property immediately adjacent to campus - All public property, including thoroughfares, streets, sidewalks, and parking facilities, that is within the campus, or immediately adjacent to and accessible from campus.

Non-campus in a University owned leased or controlled space (fraternity, sorority, off-campus classroom) - Any building or property owned or controlled by a student organization that is officially recognized by the institution; or any building or property owned or controlled by an institution that is used in direct support of, or in relation to, the institution's educational purposes, is frequently used by students, and is not within the same reasonable contiguous geographic area of the institution.

Unknown location

I do not know which category this location would fall under

Incident Description (Please provide specific, detailed information):

Please select offense that occurred:

Homicide - Murder/non-negligent manslaughter is the willful (non-negligent) killing of one human being by another;. Negligent homicide is the killing of another person through gross negligence.

Burglary - Burglary is the unlawful entry of a structure to commit a felony or a theft.

Aggravated Assault - Aggravated assault is the unlawful attack by one person upon another for the purpose of inflicting severe or aggravated bodily injury.

Robbery - Robbery is the taking or attempting to take anything of value from the care, custody, or control of a person or persons by force or threat of force or violence and/or by putting the victim in fear.

Sex Offense (Forcible) - Forcible rape is the carnal knowledge of a person forcibly and/or against the person's will; or not forcibly or against the person's will where the victim is incapable of giving consent because of his/her temporary or permanent mental or physical incapacity (or because of his/her youth). Forcible sodomy is the oral or anal sexual intercourse with another person, forcibly and/or against that person's will; where the victim is incapable of giving consent because of his/her youth or because of his/her temporary or permanent mental or physical incapacity. Sexual assault with an object is the use of an object or instrument to unlawfully penetrate, however slightly, the genital or anal opening of the body of another person, forcibly and/or against the person's will; or not forcibly or against the person's will where the victim is incapable of giving consent because of his/her youth or because of his/her temporary or permanent mental or physical incapacity. Forcible fondling is the touching of the private body parts of another person for the purpose of sexual gratification, forcibly and/or against that person's will or, not forcibly or against the person's will where the victim is incapable of giving consent because of his/her youth or because of his/her mental incapacity.

Sex Offense (Non-Forcible) - Incest is the non-forcible sexual intercourse between persons who are related to each other within the degrees wherein marriage is prohibited by law. Statutory rape is the non-forcible sexual intercourse with a person who is under the age of consent.

Motor Vehicle Theft - Motor vehicle theft is the theft or attempted theft of a motor vehicle.

Arson - Arson is the willful or malicious burning or attempt to burn with or without intent to defraud a dwelling house, public building, motor vehicle or aircraft, personal property of another, etc.

Dating Violence - Dating Violence is violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim; and where the existence of such a relationship shall be determined based on a consideration of the following factors: the length of the relationship; the type of the relationship; and the frequency of interaction between the persons involved in the relationship.

Domestic Violence - Domestic violence is the felony or misdemeanor crimes of violence committed by a current or former spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner; by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction or by any other person against an adult or youth victim who is protected from that person's acts under the domestic or family violence laws of the jurisdiction.

Stalking - Stalking is the engaging in a course of conduct directed at a specific person that would cause a reasonable person to fear for his or her safety or the safety of others, or suffer substantial emotional distress.

Arrest for Liquor Law Violation - Liquor law violation is the violation of state or local laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, or use of alcoholic beverages.

Student Conduct Referral for Liquor Law Violation - Liquor law violation is the violation of state or local laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, or use of alcoholic beverages.

Arrest for Drug Law Violation - Drug law violation is the violation of laws prohibiting the production, distribution, and/or use of certain controlled substances and the equipment or devices utilized in their preparation and/or use.

Student Conduct Referral for Drug Law Violation - Drug law violation is the violation of laws prohibiting the production, distribution, and/or use of certain controlled substances and the equipment or devices utilized in their preparation and/or use.

Arrest for Weapons Law Violation - Weapons law violation is the violation of laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, concealment, or use of firearms, cutting instruments, explosives, incendiary devices, or other deadly weapons.

Student Conduct Referral for Weapons Law Violation - Weapons law violation is the violation of laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, concealment, or use of firearms, cutting instruments, explosives, incendiary devices, or other deadly weapons.

NOTE: The following crimes are only required to be reported if the crime was motivated by bias (hate crime).

Simple Assault

Larceny

Intimidation

Vandalism

Is there any evidence that this crime was motivated by bias?

Yes

Clear selection

If yes, please choose any/all categories of bias that apply.

Race

Gender

Ethnicity

Religion

Disability

National Origin

Gender Identity

Sexual Orientation

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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