James Madison University Campus Security Authority Crime Report Form
* Required
Section A: Introduction
Originally known as the Campus Security Act, the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (20 USC § 1092(f)) is the landmark federal law that requires colleges and universities across the United States to disclose information about crime on and around their campuses. The Clery Act applies to certain crimes reported to the police and other University officials known as Campus Security Authorities (CSA's). CSA's are federally mandated crime reporters. As such, CSA’s shall report, on a timely basis, any Clery Act qualifying crime occurring on Clery geography that they are made aware of to the James Madison University Police Department. University Police will use the submitted information to verify the appropriate classification of the crime. It is important for CSA's to document sufficient incident detail to allow University Police to properly classify the crime type. An * indicates a required field.
Although CSA's should report Clery reportable crimes as they become aware of them, all Campus Security Authorities must be contacted annually and receive training and provide documentation of adherence to federal mandates. Please use this form for documentation.
Crime Reporting – It is the policy of James Madison University to ensure that the victims and witness to crimes are aware of their right to report criminal acts to the police. CSA’s should ask reporting party if they would like to report the crime to police. If the reporting party wants the police contacted, the CSA should help contact the police in the jurisdiction of the crime.
Some crimes documented by a secondary reporting agency will be automatically forwarded to the JMU Police Department. Secondary Reporting Agency(s) reporting directly to the JMU Police Department include the JMU Office of Accountability and Restorative Practice (OSARP), Title IX, and the Office of Residence Life. No further documentation is necessary.
Anonymity – If a crime reporting party requests anonymity, this request must be honored to the extent permitted by law. Accordingly, no information should be included on this form that would personally identify the victim without his/her consent.
CSA's reporting a victim reported incidence of sexual violence or harassment are encouraged to print and provide the reporting victim the JMU Complainants Rights Information.
Submission – To send the completed report form electronically, please click on the submit button when directed. You may also forward this completed form to: Lisa Carickhoff Clery Compliance, 821 South Main Street, MSC 6810 Harrisonburg, VA 22807; or FAX to JMU Police Clery Compliance at (540-568-7926); or email to caricklt@jmu.edu. .
Please review the PowerPoint training. (If you would like additional training or have questions please contact Clery Compliance Officer at caricklt@jmu.edu)
Section C: Is this a Secondary Report?
Secondary Reporting Agency(s) the incident has also been reported to for documentation
The Office of Student Accountability and Restorative Practice, Title IX, and the Office of Residence Life supply documentation of all Clery crimes reported to them. If a report has been made to them please indicate as these crimes have been documented and been forwarded. No further documentation is needed. All other incidents need to be reported.
Case Number
If Known
Law Enforcement Agency(s) The Incident Has Also Been Reported To:
Case Number
If Known
The Campus Security Report Form
Campus Security Authorities (CSA’s) shall report, on a timely basis, any Clery Act qualifying crimes occurring on Clery geography that they are made aware of to the James Madison University Police Department. University Police will use the submitted information to verify the appropriate classification of the crime. It is important for CSA’s to document sufficient incident detail to allow University Police to properly classify the crime type.
Section D: When did it happen?
Date Crime Reported to CSA
Crime Occurrence Date
If Single Date
Crime Occurrence over a Period of Time
First Occurrence
Last Occurrence
Section E: Crime Occurrence Location
Crime Occurrence Location
Please provide building name, address, street name with cross streets or close address, or nearby buildings if it occurred outside. Consult Clery Reportable Geography and Clery map as necessary.
Location Classification
Section F: Reported Crime
Check The Box That Best Indicates The Crime You Are Reporting. As Needed, Please Refer To Clery Reportable Crimes For Crime Definitions.
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.
Number of Crime Victims
Please provide a brief description of the reported crime (what happened) to help us classify it.
Section G: Hate Crime Reporting
Was the crime reported in Section E motivated by bias (was the victim specifically targeted because of prejudice i.e. a Hate Crime)?
Hate Crime
Section H: Referrals
Certain student and employee violations referred to the Office of Student Accountability and Restorative Practice, Human Resources, Office of Residence Life etc. must be reported. If a referral has been reported previously to the Office of Residence Life or Office of Student Accountability and Restorative Practice or Title IX No Further Documentation is Necessary. All other referrals must be documented. These reportable law violations include:
If A Liquor, Drug, or Weapon Law Violation Referral Is Reported, the Corresponding Number of Persons Referred Must Be Entered
Case Number
If Known
