Anonymous Crime Reporting Form

Anonymous Crime Reporting Form

1. This form is being filled out by

1. This form is being filled out by

Reporting Form

If you were a victim of a crime on campus and would like to make an anonymous report, please fill out this form. In order to assist us in accurate crime statistics, include as much information as possible. The date and time of the incident is necessary to avoid duplicate reporting. Campus crime will be reported as aggregate data for the Annual Security Report. Off-campus crime is reported as aggregate data and collected by the University. If you would like more information about resources available to you or help with understanding your options or making a police report, call the Campus Advocacy Network 312.996.8393 or the Office of the Dean of Students (312) 996-4857 and someone will assist you. The police can be contacted directly to make a report by calling (312) 355-5555 for an emergency or 312 996-2830 for a non-emergency. For more resources select this link

Crime Victim Information:

(Please check the following boxes and fill in the blanks).

2. Gender:

2. Gender:

 

 

(check all that apply)

5. Race/Ethnicity

5. Race/Ethnicity

(check all that apply)

6. Campus Affiliation

6. Campus Affiliation

7. If you are a student, please indicate year in school

7. If you are a student, please indicate year in school

Assailant Information:

(Please check the following boxes and fill in the blanks).

8. Gender:

8. Gender:

 

 

(check all that apply)

11. Race/Ethnicity

11. Race/Ethnicity

(check all that apply)

12. Campus Affiliation

12. Campus Affiliation

13. If you are a student, please indicate year in school

13. If you are a student, please indicate year in school

Incident Information

answer must be date like mm/dd/yyyy

  start datechoose a start date

 

16. Indicate time whether a.m. or p.m.

16. Indicate time whether a.m. or p.m.

(Provide a description of what happened. Do not include names).

(Provide a description of what happened. Do not include names).

18. Type of crime

18. Type of crime

19. Location of the Incident:

19. Location of the Incident:

20. Force Used:

20. Force Used:

(Check all that apply)

22. Relationship with the Assailant:

22. Relationship with the Assailant:

(Check all that apply)

(Check all that apply)

23. What on- and off-campus resources have been contacted directly or on behalf of the crime victim

23. What on- and off-campus resources have been contacted directly or on behalf of the crime victim

(Check all that apply)