Clery Act Crime Reporting Form
This form should be completed by Campus Security Authorities (CSAs) who are required to report information they receive about crimes pursuant to the Clery Act. The information collected from these forms will be used to prepare a compilation of statistical crime information that will be included in the university’s Annual Security Report. It is imperative all victims and witnesses are aware of their right to report criminal acts to the police, and to report University policy violations to the appropriate office (e.g., Resident Life, Student Life). However, if a reporting person requests anonymity, this request must be honored to the extent permitted by law. If the person reporting this crime to you does not wish to be personally identified, please complete the form to the best of your ability without identifying that person. Queens Campus Police will use this form to determine the category of crime and location under which the crime should be reported according to the requirements of the Clery Act. If the Queens Campus Police report to the scene, your reporting requirement is met and this form does NOT need to be completed.

You can access the CSA Reporting From at

https://queens-yhcyj.formstack.com/forms/travel_itinerary_institutional_sponsored_trips

If you have any question, please do not hesitate to contact Pam Peterson by phone at (704) 337-2481 or by email at petersonp@queens.edu