Campus Security Authority Incident Report Form

Who Should Use This Form?

The form below should be used by Campus Security Authorities to report crimes under the Clery Act that they have knowledge of but were not formally reported to or investigated by the Police Department. This is an anonymous form that allows the Police Department to more accurately track the number of crimes that are actually occurring for Clery reporting purposes. It is important to the members of Valdosta State University Police Department that the crime statistic information that it provides to the public is as clear and as accurate as it possibly can be.

The following crimes should be reported using this form:

  • Murder/Non-Negligent Manslaughter – The willful killing of one human being by another.
  • Manslaughter by Negligence – The killing of another person through gross negligence.
  • Sexual Assault
    • Rape – 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. This includes both males and females.
    • Fondling – The touching of the private body parts of another person for the purpose of sexual gratification, forcibly and/or against that person’s will; or not forcibly or against that person’s will where the victim is incapable of giving consent because of his/her youth or because of his/her temporary or permanent mental incapacity.
    • Incest – Non-forcible sexual intercourse between persons who are related to each other within the degrees wherein marriage is prohibited by law.
    • Statutory Rape – Non-forcible sexual intercourse with a person who is under the statutory age of consent.
  • Robbery – Taking or attempting to take anything of value from the care, custody or control of a person or persons by force or threat of violence and/or by putting the victim in fear.
  • Aggravated Assault – Unlawful attack by one person upon another for the purpose of inflicting severe or aggravated bodily injury. Usually accompanied by the use of a weapon or by means likely to produce death or bodily harm.
  • Burglary – Unlawful entry of a structure to commit a felony or a theft.
  • Motor Vehicle Theft – The theft or attempted theft of a motor vehicle. There are three classes of motor vehicle (1) autos, (2) trucks and buses, (3) and other vehicles.
  • Arson – Willful or malicious burning or attempt to burn with or without intent to defraud a dwelling house, public building, motor vehicle or aircraft, or the personal property of another.
  • Relationship/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. The violence can: (a) Inflict physical injury upon another person; or (b) Places another in fear of, or at risk of, physical injury or danger. It is not limited to sexual or physical abuse or threat of such abuse.
  • Stalking:
    • (a) Engaging in a course of conduct directed at a specific person that would cause a reasonable person to:
      • (i) Fear for the persons safety or the safety of others; or
      • (ii) Suffer substantial emotional distress.
  • Hate Crime – Any of the above offenses (in addition to damage to property, larceny, simple assault, and intimidation) that manifest evidence that the victim was intentionally selected because of the perpetrator’s bias against the victim or the perpetrator perceived the person to be in one of the protected group categories.


  • On Campus (Residence Hall)
    On Campus (Other than Residence Hall)
    Non-Campus Property (owned, controlled, or affiliated with campus; e.g., leased property, fraternities)
    Public Property immediately adjacent to campus (sidewalk, street, sidewalk which are adjacent to campus)
    Off Campus, Not affiliated or adjacent to campus (e.g., City of Valdosta)
    Unknown
  • Yes
    No
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