Campus Security Authority Disclosure Form

 

This form is only for the anonymous reporting of specific Clery Act crimes that have already occurred within specific areas of campus.

As a Campus Security Authority you must report information that could pose an immediate risk to the campus community to the Clayton State University Public Safety Department at 678-466-4050. Submitting this form does not satisfy any reporting obligations under Title IX.

This form is to be used by a Campus Security Authority to submit information on Clery Crimes that occur in the Clayton State University Clery Geography. Clery Crimes include Murder, Non-Negligent Manslaughter, Negligent Manslaughter, Rape, Fondling, Incest, Statutory Rape, Robbery, Aggravated Assault, Burglary, Motor Vehicle Theft, Arson, Weapon Law Violations, Drug Law Violations, Liquor Law Violations, Stalking, Domestic Violence, Dating Violence.

If the victim does not wish for their personal information to be shared, please leave that information blank. Please include as much information in the Narrative Description Field as possible. Include details such as times, specific locations, perpetrators, and specifics of any criminal acts. If you believe that this incident may have been a hate crime, list any specific circumstances that lead you to believe this.

Nature of Incident
Location of Incident
Note: Off-Campus apartments are not campus owned residence halls.