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Clery Act Crime
Report Form
Your Name:
Your Phone Number:

Crime Classification (Expanded definitions of crimes listed below)

Date of Incident: (ie:January 1, 20xx)
Location of Incident:
Brief Description:

Was the crime reported to a law enforcement agency? Yes No
If so, which one? KU Public Safety Lawrence Police Department Other Did the crime occur in a building or on the street? Building Street
Did the crime occur on KU owned, controlled or leased property? Yes No
Did the crime occur at a University-sponsored activity or event? Yes No