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Anonymous Crime Reporting Form

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).

Gender:

2. Gender:
 
 
 
 

 

 
(check all that apply)

Question 5

5. Race/Ethnicity
(check all that apply)
 
 
 
 
 
 
 

Question 6

6. Campus Affiliation
 
 
 
 

Question 7

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

Assailant Information:

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

Gender:

8. Gender:
 
 
 
 

 

 
(check all that apply)

Question 11

11. Race/Ethnicity
(check all that apply)
 
 
 
 
 
 
 
 

Question 12

12. Campus Affiliation
 
 
 
 
 

Question 13

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

Incident Information

answer must be date like mm/dd/yyyy

  start dateclick calendar to choose a start date    date rules

 

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).

Question 18

18. Type of crime
 
 
 
 
 
 
 
 
 
 
 

Question 19

19. Location of the Incident:
 
 
 
 
 
 
 

Question 20

20. Force Used:
 
 
 
 
 
 

(Check all that apply)

Question 22

22. Relationship with the Assailant:
(Check all that apply)
 
 
 
 
 
 
 
 
 
 
(Check all that apply)

Question 23

23. What on- and off-campus resources have been contacted directly or on behalf of the crime victim
(Check all that apply)
 
 
 
 
 
 
 
 

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