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CSA Crime Reporting Form : UVM Police Services

University of Vermont
Campus Security Authority Reporting Form

If you are a Campus Security Authority (CSA) and you have become aware of an (alleged) crime occurring on or near campus property, please use this form to report required information. As a CSA, you must include your name and contact information in the event follow-up is needed. If confidentiality is requested by the victim, the victim‘s name(s) need not be included in Section I of this Form.

If you believe there is an immediate or ongoing threat to the safety of an individual(s), call 911.

If an alleged victim wishes to file a police report, please advise and assist them to contact UVM Police Services directly at (802) 656-3473. In the event of an emergency, always call 911.

If you need assistance filling out this form, or otherwise require an accommodation, please contact UVM Police Services at (802) 656-3473.


  • Note: CSAs must contact Police and share all names for allegations of domestic violence and/or stalking, and for all allegations or suspicion of abuse and/or neglect of minors.

    Part 1: Criminal Offenses

    To the best of your knowledge, did the incident constitute any of the following criminal offenses? Check all that apply:

  • Part 2: Hate Crimes and Bias Incidents
  • In accordance with the Clery Act and University Policy, the criminal offenses listed above, as well as those listed in this section, are separately reportable as hate crimes if motivated by the offender‘s bias. If there is evidence that the crime you have selected above or in this section was motivated by bias, please check off both an underlying crime AND a type of bias (check all that apply):

  • A. Underlying Crime
    B. Type of Bias:


    Did the incident occur in any of the following locations? Check those that apply:


    To the best of your knowledge, were any of the following offices or agencies notified of this incident? Check all that apply:

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    Clery Act Crime Definitions*

    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. Note: It is not necessary that injury result from an aggravated assault when a gun, knife or other weapon is used which could or probably would result in a serious potential injury if the crime were successfully completed.
    The willful or malicious burning or attempt to burn, with or without intent to defraud, a dwelling house, public building, motor vehicle or aircraft, or personal property of another kind.
    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 a felony: breaking and entering with intent to commit a larceny; housebreaking; safecracking; and all attempts to commit any of the aforementioned.
    Dating Violence:
    Due to the inclusion of “household members” in the definition of domestic violence under Vermont law [15 V.S.A. § 1101], ‘Dating Violence’ is not separately reportable by the University of Vermont.
    Domestic Violence:
    Felony or misdemeanor crimes of violence committed by a current or former spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner, or, in accordance with Vermont law [15 V.S.A. § 1101], by persons who, for any period of time, are living or have lived together, are sharing or have shared occupancy of a dwelling, are engaged in or have engaged in a sexual relationship, or minors or adults who are dating or who have dated [“household members”].
    Forcible 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 or physical incapacity.
    Non-forcible sexual intercourse between persons who are related to each other within the degrees wherein marriage is prohibited by law.
    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 joy riding.)
    Murder/Non-Negligent Manslaughter:
    The willful (non-negligent) killing of one human being by another. NOTE: deaths caused by negligence, attempts to kill, assaults to kill, suicides, accidental deaths, and justifiable homicides are excluded.
    Negligent Manslaughter:
    The killing of another person through gross negligence.
    The carnal knowledge of a person, 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 or physical incapacity.
    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.
    Engaging in a course of conduct directed at a specific person that would cause a reasonable person to fear for his or her safety or the safety of others, or suffer substantial emotional distress.
    Statutory Rape:
    Non-forcible sexual intercourse with a person who is under the statutory age of consent.

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    Hate Crimes

    In addition to the offenses against persons and offenses against property listed above, where a victim is intentionally selected because of their actual or perceived race, gender, religion, sexual orientation, gender identity, ethnicity, national origin, or disability, the following crimes shall be reported according to the category of bias evidenced.

    Destruction/Damage/Vandalism of Property:
    The willful or malicious destruction, damage, defacing, or other injury to real or personal property without the consent of the owner or the person having custody or control of it.
    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.
    The unlawful taking, carrying, leading, or riding away of property from the possession or constructive possession of another. Constructive possession is the condition in which a person does not have physical custody or possession, but is in a position to exercise dominion or control over a thing.
    Simple Assault:
    The 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.

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    * All crime definitions have been adopted from the Federal Bureau of Investigation’s Uniform Crime Reporting Handbook (UCR), the National Incident-Based Reporting System (NIBRS) Edition of the UCR for sex offenses, and the Violence Against Women Reauthorization Act (VAWA) of 2013 for domestic (including dating) violence and stalking, respectively.

    Last modified June 13 2018 09:19 PM

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