Clery Incident Reporting Form

If this incident poses an immediate risk to life, safety, or property, do not fill out this form. Instead, call 911 or University Police at 301.687.4222.


This form should only be completed by a Campus Security Authority (CSA) when the victim/witness does not wish to report the incident to University Police. This online form is solely for the purpose of tracking crime statistics in order to comply with federal law.

Anonymous Reporting

One of the purposes of the Clery Act is to encourage reporting and disclosure of accurate campus crime statistics in order to promote crime awareness and enhance campus safety. As a CSA, you must include your name and contact information in the event follow-up is needed. If the victim requests confidentiality, their name does not need to be included.

Other mandatory reporting obligations

Use of this form does not replace or exchange any existing requirements or procedures regarding mandatory reporting of child abuse/neglect or sexual misconduct.

Clery Act Crime Definitions

  • Aggravated Assault: An unlawful attack by one person upon another for the purpose of inflicting severe or aggravated bodily injury. This type of assault is usually accompanied by the use of a weapon or by means likely to produce death or great bodily harm. It is not necessary that injury result from an aggravated assault when a gun, knife, or other weapon is used which could and probably would result in serious personal injury if the crime were successfully completed. Attempts to kill or murder are included in this category.
  • Arson: Any willful or malicious burning or attempt to burn, with or without intent to defraud, a dwelling house, public building, motor vehicle or aircraft, or personal property of another.
  • Burglary: The unlawful entry of a structure to commit a felony of theft. Unlawful entry with intent to commit a larceny or felony; breaking and entering with intent to commit a larceny; housebreaking; safecracking; and all attempts to commit any of the aforementioned are included in this category.
  • Dating Violence: Violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim. The existence of such relationship is determined based on a consideration of the following: (i) the length of the relationship, (ii) the type of relationship, and (iii) the frequency of interaction between the persons involved in the relationship.
  • Domestic Violence: A felony or misdemeanor crime of violence committed by: (i) a current or former spouse of the victim; (ii) by a person with whom the victim shares a child in common; (iii) by a person who is cohabitating with or has cohabitated with the victim as a spouse; (iv) by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction where the crime occurred; or (v) 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 where crime occurred.
  • Drug Abuse Violation: The violation of state or local laws relating to the unlawful possession, sale, use, growing, manufacturing, and making of narcotic drugs. The relevant substances include opium or cocaine and their derivatives (morphine, heroin, codeine); marijuana; synthetic narcotics (Demerol, methadone); and dangerous non-narcotic drugs (barbiturates, Benzedrine). Also includes all illegally obtained prescription drugs.
  • Fondling: The touching of the private body parts of another person for the purpose of sexual gratification, without the consent of the victim, including instances where the victim is incapable of giving consent because of their age or because of their temporary or permanent mental incapacity.
  • Incest: Sexual intercourse between persons who are related to each other within the degrees wherein marriage is prohibited by law.
  • Intimidation: To unlawfully place another person in reasonable fear of bodily harm through the use of threatening words and/or other conduct, but without displaying a weapon or subjecting the victim to actual physical attack. Reported only if classified as a hate crime (see Hate Crime section below).
  • Larceny-Theft: The unlawful taking, carrying, leading, or riding away of property from the possession or constructive possession of another. Attempted larcenies are included in this category, but embezzlement, confidence games, forgery, and worthless checks are excluded. Reported only if classified as a hate crime (see Hate Crime section below).
  • Liquor Law Violation: The violation of laws or ordinances prohibiting the manufacturing, sale, transporting, furnishing, possessing of intoxicating liquor; maintaining unlawful drinking places; bootlegging; operating a still; furnishing liquor to a minor or intemperate person; underage possession; using a vehicle for illegal transportation of liquor; drinking on a train or public conveyance; and all attempts to commit any of the aforementioned. Drunkenness and driving under the influence are not included in this category.
  • Motor Vehicle Theft: The theft or attempted theft of a motor vehicle. This includes all cases where automobiles are taken by persons not having lawful access even though the vehicles are later abandoned—including joyriding. Theft from a motor vehicle is not included in this category.
  • Murder/Non-Negligent Manslaughter: The willful (non-negligent) killing of one human being by another. Includes any deaths caused by injuries received in a fight, argument, quarrel, assault, or the commission of a crime. Suicides, accidental deaths, justifiable homicides, attempted murder, and deaths caused by negligence are excluded from this category.
  • Negligent Manslaughter: The killing of another human being through gross negligence. Deaths of persons due to their own negligence; accidental deaths not resulting from gross negligence; and traffic fatalities are excluded from this category.
  • Rape: The penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ by another person, without the consent of the victim. This offense includes the rape of both males and females.
  • Robbery: 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.
  • Simple Assault: An unlawful physical attack by one person upon another where neither the offender displays a weapon, nor the victim suffers obvious severe or aggravated bodily injury involving apparent broken bones, loss of teeth, possible internal injury, severe laceration, or loss of consciousness. Reported only if classified as a hate crime (see Hate Crime section below).
  • Stalking: Engaging in a course of conduct directed at a specific person that would cause a reasonable person to (A) fear for the person’s safety or the safety of others; or (B) suffer substantial emotional distress. For the purposes of this definition: (i) course of conduct means two or more acts, including but not limited to, acts in which the stalker directly, indirectly, or through third parties, by any action, method, device, or means, follows, monitors, observes, surveils, threatens, or communicates to or about a person, or interferes with a person’s property; (ii) reasonable person means a reasonable person under similar circumstances and with similar identities to the victim; (iii) substantial emotional distress means significant mental suffering or anguish that may, but does not necessarily, require medical or other professional treatment or counseling.
  • Statutory Rape: Sexual intercourse with a person who is under the statutory age of consent.
  • Vandalism of Property: To willfully or maliciously destroy, damage, deface, or otherwise injure real or personal property without the consent of the owner or the person having custody or control of it. Reported only if classified as a hate crime (see Hate Crime section below).
  • Weapons Violation: The violation of laws or ordinances dealing with weapon offenses that are regulatory in nature, such as: the manufacture, sale, or possession of deadly weapons; carrying deadly weapons, concealed or openly; furnishing deadly weapons to minors; aliens possessing deadly weapons; and all attempts to commit any of the aforementioned.
Reporter/Campus Security Authority Information

Incident Description

(check all that apply)

(Please provide the specific location and/or address of the incident, if known)

(if willing to be shared with University Police)

Type of Incident

(check all that apply)

(check all that apply)
Hate Crimes
The Clery Act requires CSAs to separately report if any of the above-listed offenses, or those listed below were motivated by the offender’s bias.

(check all that apply)

(check all that apply)