This form should be completed by those individuals as "campus security authorities" who are required to report information they receive about specified crimes pursuant to the federal 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 campus' Annual Security Report.

It is the policy of Simpson College to ensure that victims and witnesses to crime are aware of their fight to report criminal acts to the police, and to report College policy violations to the appropriate office (e.g., student conduct violations to the Office of Security.) However, if a reporting person 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.

The Office of Security will use the form to determine the category of crime and location under which the crime should be reported according to the requirements of the Clery Act.