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CSA Incident Report

If this is an emergency call 911.

One of the purposes of The Clery Act is to encourage accurate and timely reporting of campus crime statistics. An important goal of the Clery Act is to provide information to the campus community to promote crime awareness and to enhance campus safety through providing prompt disclosures and reliable statistics for campus area crimes. This form provides campus security authorities (CSAs) (other than University Police) with a uniform method to document reported crimes that have occurred on or around Texas State University. The Clery Act defines CSAs as someone who has significant responsibility for student and campus activities. If you are a CSA, the University should have notified you and provided you with training. If you think you are a CSA and you have not been identified, please reach out to cleryreport@txstate.edu.

We will not use this information to identify the victim, but rather to meet Clery Act requirements and increase public safety.

Texas State University encourages reporting crime to the police. We understand and support victims who wish to report crime to CSAs other than University Police. As a CSA, you may be the only University official to whom a victim reports the crime. Your attempt to gather information in this form in a supportive and empathetic way is critical to maximizing campus safety.

For Clery Act purposes, Texas State University affiliation of the involved parties is not a relevant fact as to whether this report form is to be completed. You must complete this form regardless. If you get a crime report you think may be for a Clery Act crime or you think may have happened in Clery Act geography, you must fully document it.

Directing or referring the reporting party to the University Police does not satisfy the Clery Act. In order for the University to satisfy its critical Clery Act requirements, all CSA's must complete this form as soon as they learn of crimes. In addition, CSAs must respond to an annual request by the Clery Act Compliance Specialist to gather crime data.


CSA (Your) Contact Information


Clery Act Incident Information

An incident may describe more than one type of crime. Using the following list, please be sure to identify each crime the victim described to you.

Criminal Homicide - Manslaughter by Negligence

The killing of another person through gross negligence.

Criminal Homicide - Murder and Nonnegligent Manslaughter

The willful (nonnegligent) killing of one human being by another.

Sexual Offenses (include Rape, Fondling, Incest, Statutory Rape)

Any sexual act directed against another person, without the consent of the victim, including instances where the victim is incapable of giving consent.

Rape

The penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.

Fondling

The touching of the private body parts of another person for the purpose of sexual gratification, without the consent of the victim, including instances where the victim is incapable of giving consent because of his/her age or because of his/her temporary or permanent mental incapacity.

Incest

Sexual intercourse between persons who are related to each other within the degrees wherein marriage is prohibited by law.

Statutory Rape

Sexual intercourse with a person who is under the statutory age of consent.

Robbery

The taking or attempting to take anything of value from the care, custody, or control of a person or persons by force or threat of force or violence and/or by putting the victim in fear.

Aggravated Assault

An unlawful attack by one person upon another for the purpose of inflicting severe or aggravated bodily injury. This type of assault usually is accompanied by the use of a weapon or by means likely to produce death or great bodily harm. (It is not necessary that injury result from an aggravated assault when a gun, knife, or other weapon is used which could and probably would result in serious personal injury if the crime were successfully completed).

Burglary

The unlawful entry of a structure to commit a felony or a theft. For reporting purposes this definition includes: unlawful entry with intent to commit a larceny or felony; breaking and entering with intent to commit a larceny; housebreaking; safecracking; and all attempts to commit any of the aforementioned.

Motor Vehicle Theft

The theft or attempted theft of a motor vehicle. (Classify as motor vehicle theft all cases where automobiles are taken by persons not having lawful access even though the vehicles are later abandoned—including joyriding.)

Arson

Any willful or malicious burning or attempt to burn, with or without intent to defraud, a dwelling house, public building, motor vehicle or aircraft, personal property of another, etc.

 

Hate Crime Definitions

Hate crime

A crime reported to local police agencies or to a campus security authority that manifests evidence that the victim was intentionally selected because of the perpetrator’s bias against the victim. For the purposes of this section, the categories of bias include the victim’s actual or perceived race, religion, gender, gender identity, sexual orientation, ethnicity, national origin, and disability. The crimes of Larceny-Theft, Simple Assault, Intimidation, Destruction/Damage/Vandalism of Property are also reported under Clery Act requirements if it is determined the victim was intentionally selected because of the perpetrators’ bias against the victim.

Larceny-Theft (Except Motor Vehicle Theft)

The unlawful taking, carrying, leading, or riding away of property from the possession or constructive possession of another. Attempted larcenies are included. Embezzlement, confidence games, forgery, worthless checks, etc., are excluded.

Simple Assault

An unlawful physical attack by one person upon another where neither the offender displays a weapon, nor the victim suffers obvious severe or aggravated bodily injury involving apparent broken bones, loss of teeth, possible internal injury, severe laceration, or loss of consciousness.

Intimidation

To unlawfully place another person in reasonable fear of bodily harm through the use of threatening words and/or other conduct, but without displaying a weapon or subjecting the victim to actual physical attack.

Destruction/Damage/Vandalism of Property

To willfully or maliciously destroy, damage, deface, or otherwise injure real or personal property without the consent of the owner or the person having custody or control of it.
 

Dating Violence

Violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim. 

Domestic Violence

A felony or misdemeanor crime of violence committed by a current or former spouse or intimate partner of the victim, a person with whom the victim shares a child in common, a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner, a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred, or by any other person against an adult or youth victim who is protected from that person’s acts under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred.

Stalking

Engaging in a course of conduct directed at a specific person that would cause a reasonable person to fear for the person’s safety or the safety of others; or suffer substantial emotional distress. For the purpose of this definition Course of conduct means two or more acts, including, but not limited to, acts in which the stalker directly, indirectly, or through third parties, by any action, method, device, or means follows, monitors, observes, surveils, threatens, or communicates to or about, a person, or interferes with a person’s property. Substantial emotional distress means significant mental suffering or anguish that may, but does not necessarily, require medical or other professional treatment or counseling. Reasonable person means a reasonable person under similar circumstances and with similar identities to the victim.

Liquor Law Violations

The violation of state or local laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, or use of alcoholic beverages, not including driving under the influence and drunkenness.

Drug Abuse Violations

The violation of laws prohibiting the production, distribution, and/or use of certain controlled substances and the equipment or devices utilized in their preparation and/or use. The unlawful cultivation, manufacture, distribution, sale, purchase, use, possession, transportation, or importation of any controlled drug or narcotic substance. Arrests for violations of state and local laws, specifically those relating to the unlawful possession, sale, use, growing, manufacturing, and making of narcotic drugs.

Weapons: Carrying, Possessing, Etc.

The violation of laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, concealment, or use of firearms, cutting instruments, explosives, incendiary devices, or other deadly weapons.

Referred for campus disciplinary action (Liquor Laws, Drugs and Weapons Violations):

The referral of any person to any campus official who initiates a disciplinary action of which a record is established and which may result in the imposition of a sanction.

Select all applicable offenses *
Type of Law Violation (if applicable)

Description of Crime


Bias Discrimination, Hate Crimes

Race

A preformed negative attitude toward a group of persons who possess common physical characteristics, e.g., color of skin, eyes, and/or hair; facial features, etc., genetically transmitted by descent and heredity which distinguish them as a distinct division of humankind, e.g., Asians, blacks or African Americans, whites.

Religion

A preformed negative opinion or attitude toward a group of persons who share the same religious beliefs regarding the origin and purpose of the universe and the existence or nonexistence of a supreme being, e.g., Catholics, Jews, Protestants, atheists.

Sexual Orientation

A preformed negative opinion or attitude toward a group of persons based on their actual or perceived sexual orientation. Sexual Orientation is the term for a person’s physical, romantic, and/or emotional attraction to members of the same and/or opposite sex, including lesbian, gay, bisexual, and heterosexual (straight) individuals.

Gender

A preformed negative opinion or attitude toward a person or group of persons based on their actual or perceived gender, e.g., male or female.

Gender Identity

A preformed negative opinion or attitude toward a person or group of persons based on their actual or perceived gender identity, e.g., bias against transgender or gender non-conforming individuals. Gender non-conforming describes a person who does not conform to the gender-based expectations of society, e.g., a woman dressed in traditionally male clothing or a man wearing makeup. A gender non-conforming person may or may not be a lesbian, gay, bisexual, or transgender person but may be perceived as such.

Ethnicity

A preformed negative opinion or attitude toward a group of people whose members identify with each other, through a common heritage, often consisting of a common language, common culture (often including a shared religion) and/or ideology that stresses common ancestry. The concept of ethnicity differs from the closely related term “race” in that “race” refers to a grouping based mostly upon biological criteria, while “ethnicity” also encompasses additional cultural factors.

National Origin

A preformed negative opinion or attitude toward a group of people based on their actual or perceived country of birth. This bias may be against people that have a name or accent associated with a national origin group, participate in certain customs associated with a national origin group, or because they are married to or associate with people of a certain national origin.

Disability

A preformed negative opinion or attitude toward a group of persons based on their physical or mental impairments, whether such disability is temporary or permanent, congenital or acquired by heredity, accident, injury, advanced age or illness.

 

If so, please select all that apply:

Location of Incident

On-Campus:

Any building or property owned or controlled by an institution of higher education within the same reasonably contiguous geographic area of the institution and used by the institution in direct support of, or in a manner related to, the institution’s educational purposes, including student halls; and property within the same reasonably contiguous geographic area of the institution that is owned by the institution but controlled by another person, is frequently used by students, and supports institutional purposes (such as a food or other retail vendor).

On-campus Subset: On-campus Student Housing:

Any student housing facility that is owned or controlled by the institution, or is located on property that is owned or controlled by the institution, and is within the reasonably contiguous geographic area that makes up campus.

Non-campus building or property:

Any building or property owned or controlled by a student organization recognized by the institution; and any building or property (other than a branch campus) owned or controlled by an institution of higher education that is used in direct support of, or in relation to, the institution’s educational purposes, is frequently used by students, and is not within the same reasonably contiguous geographic area of the institution.

Public Property:

All public property, including thoroughfares, streets, sidewalks, and parking facilities, that are within the campus, or adjacent to and accessible from a facility owned or controlled by the institution.

Separate Campus:

A separate location that the institution owns or controls, is not reasonably geographically contiguous with the main campus, has an organized program of study, and there is at least one person on site acting in an administrative capacity. (Round Rock)

Noncampus Subset: School-sponsored Trips:

If your institution sponsors students on an overnight trip every year and the students stay in the same hotel each year, you must include portions of the hotel in your noncampus geography. What matters is repeated use of a location that is owned or controlled by the institution, not the number of days it is used or whether it is used by the same students or different students.

Noncampus Subset: Short-stay “away” trips

If your institution sponsors short-stay “away” trips of more than one night for its students, all locations used by students during the trip, controlled by the institution during the trip and used to support educational purposes should be treated as noncampus property.

Noncampus Subset: Study abroad programs

If your institution sends students to study abroad at a location or facility that you don’t own or control, you don’t have to include statistics for crimes that occur in those facilities. However, if your institution rents or leases space for your students in a hotel or student housing facility, you are in control of that space for the time period covered by your agreement. Host family situations do not normally qualify as noncampus locations unless your written agreement with the family gives your school some significant control over space in the family home.


Date / Time of Incident


Who Reported This to You?

If "yes", please offer assistance with notifying the police as it is required under 34 CFR 668.46(b)(11)(v).


If "No" was selected to the question above (requesting confidentiality), CSAs are required to answer the following:

Victim's Campus Affiliations: