Campus Security Authority Reporting Form

Campus Security Authority Reporting Form

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Clery Act Campus Security Reporting Form

Complete this form if a Clery crime or incident was reported to you. This form is used to gather statistical information to aid the College in compiling required statistics related to crimes that occur on campus and other College owned or controlled property. The collection of this information is required by the Higher Education Act and the Clery Act. This is NOT a report for the purposes of initiating a criminal investigation. However, Public Safety personnel will review this information to evaluate crime trends and to determine whether the circumstances reported require the issuance of a campus-wide warning.

Complete this form if a Clery crime or incident was reported to you. This form is used to gather statistical information to aid the College in compiling required statistics related to crimes that occur on campus and other College owned or controlled property. The collection of this information is required by the Higher Education Act and the Clery Act. This is NOT a report for the purposes of initiating a criminal investigation. However, Public Safety personnel will review this information to evaluate crime trends and to determine whether the circumstances reported require the issuance of a campus-wide warning.
Name
Please provide the date the crime occurred. If the date is not known, please provide a time frame.
Has this incident been reported to another College office?

Select THE BEST ANSWER TO THE FOLLOWING QUESTIONS: Clery statistics group incidents based on the location where the event occurred. Locations are categorized as follows: On campus; On campus student housing; On public property (state roads or sidewalks running through campus), and on non-campus property (property that is owned or controlled by the College but not part of the main campus).
Campus and/or Location of Incident
Pick the choice that best describes the location where the incident occurred .
Did the crime occur on property owned, controlled, or leased by the College or College affiliated organization?

CLASSIFICATION

Please choose the best classification based on your knowledge of the incident. Definitions of the listed incidents can be found above.
Clery Act Offenses
Other Offenses
Hate Crimes
A hate crime is any of the above listed crimes that include some evidence that the offender was motivated by bias or hate toward a particular class of person or people. The type of bias should be indicated below.
Sex Offenses
Was the victim that told they can report this incident to the Denmark Tech Department of Public Safety (DTCDPS)?
Does the victim wish to have police involvement?
Does the victim understand that they may contact the DTCDPS at any time if they change their mind?
If there are any other details about this event you would like to share, you may do so here.

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Physical Address:
1126 Solomon Blatt Blvd.
Denmark, South Carolina
29042-0327

Mailing Address:
P.O. Box 327
Denmark, South Carolina
29042-0327

Tel: (803) 793-5176
Fax: (803) 793-5942

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