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CSA Crime Report Form

Section I

This Report Form is only to be used by designated Campus Security Authorities (CSAs) to report Clery Act incidents. All others should contact the DSU Police Department directly.

Submission of this report will not open a police investigation. The information will be used to determine whether there is a serious and ongoing threat to the Delaware State University community and to classify, count and report Clery crimes. The incident will be included in the Daily Crime Log without any personally identifying information.

Introduction

Campus Security Authorities (CSA) are required by Federal law to report, on a timely basis, any Clery Act crimes that they are made aware of to the DSU Police Department. University Police will use the submitted information to verify the appropriate classification of the crime. It is important for CSAs to document sufficient incident detail to allow University Police to properly classify the crime type.

Submission - To send the completed report form electronically, please click on the submit button at bottom of this form.

Section I 

Dates Reported

Crime Occurrence

First Occurrence
Last Occurrence

Section II - Crime Occurrence Location

1200 N. DuPont Hwy, Dover, DE 19901
(University Leased or Controlled Off-Campus Property)
(Within or Immediately Adjacent to On-Campus Property)
(Use this box if unsure whether incident occurred at a Clery reportable location)

Section III - Reported Crime

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.

Section IV - Hate Crime Reporting

Was the crime reported in Section D motivated by bias (was the victim specifically targeted because of prejudice, i.e. a Hate Crime)?

Hate Crime

Section V - Referrals

Certain student and employee violations referred to Student Affairs, Human Resources, etc. must be reported. These reportable law violations include:

Enter Number of Persons
Enter Number of Persons
Enter Number of Persons

If a liquor, drug, or weapon law violation referral is reported, the corresponding number of persons referred must be entered. Refer to Section 2 in Clery Information pdf.

Section VI - Reporting CSA Contact Information

Name
First
Last

Section VII - General Information