Fillable Campus Security Authority (CSA) Crime Reporting Form (Collin County Community College District)

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Campus Security Authority (CSA) Crime Reporting Form (Collin County Community College District)

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Revised 11/20/2020
Page 1 of 8
Campus Security Authority (CSA)
Crime Reporting Form
Pursuant to the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (Clery Act), Collin College
is required to collect and disclose statistics regarding the occurrence of certain criminal offenses that are reported to college
officials designated as a campus security authority (CSA). Additionally, Collin College has a responsibility to notify the campus
community about any crimes which pose an ongoing threat to the community. Therefore, CSAs are obligated by federal law to
report crimes which fall under one (1) or more of the classifications listed below to the Collin College Police Department.
This form is to be completed by the CSA every time a criminal offense is reported that occurs on campus, in or on non-campus
buildings or property owned or controlled by Collin College, and on public property within or immediately adjacent to campus. If
there is an ongoing threat or imminent danger to members of the campus community, contact the Collin College Police
Department immediately at 972.578.5555.
You must download this form and save it to your computer before filling it out in order for the information to save correctly.
Completed forms must be submitted as soon as possible to:
Lt. Don Mewbourn
Collin College Police Department
Plano Campus, Room K-119
Phone: 972.881.5643
Email: clery@collin.edu
CSA’s Information
CSA's First Name: CSA’s Last Name:
CSA's Phone Number: CSA's Collin College Email Address:
Incident Information
Date Incident Reported to CSA: Incident Reported By: Date(s) Incident Occurred:
Alleged Victim’s First and Last Names (If unknown, type “Unknown.” If they requested to remain anonymous, type “Anonymous.”):
Alleged Perpetrator’s First and Last Names (If unknown, type “Unknown.” If they requested to remain anonymous, type “Anonymous.”):
Location of Incident:
Did the incident occur in a building or on the street? Building Street Both Unknown
Did the incident occur on property owned or controlled by Collin College? Yes No
Did the incident occur at a Collin College-sponsored activity or event? Yes No
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Has this incident been reported to any other individual(s) or organization(s)? Yes* No
*If yes, to which individual(s) or organization(s)?
Description of Incident
Describe the incident below. Include details such as what occurred, the specific location(s), who was involved, names of witnesses, etc.
Crime Classification
Select the appropriate crime from the lists below. If more than one (1) crime occurred, select all that apply. Crime definitions can be found
on pages 4-8.
Clery Act Offense(s):
Aggravated Assault Fondling
Arrests: Drug Abuse Violations Incest
Arrests: Liquor Law Violations Manslaughter by Negligence
Arrests: Weapons: Carrying, Possessing, Etc. Motor Vehicle Theft
Arson Murder and Non-negligent Manslaughter
Burglary Rape
Disciplinary Referrals: Drug Abuse Violations Robbery
Disciplinary Referrals: Liquor Law Violations Statutory Rape
Disciplinary Referrals: Weapons: Carrying, Possessing, Etc.
Violence Against Women Act (VAWA) Offense(s):
Dating Violence Domestic Violence Stalking
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If a hate crime was reported, select both the hate crime and the appropriate type of bias from the lists below.
Hate Crime(s):
Aggravated Assault Larceny - Theft
Arson Motor Vehicle Theft
Burglary Murder and Non-negligent Manslaughter
Destruction/Damage/Vandalism of Property Rape
Fondling Robbery
Incest Simple Assault
Intimidation Statutory Rape
Type(s) of Bias:
Disability Ethnicity Gender Gender Identity
National Origin Race Religion Sexual Orientation
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Clery Act Crimes and Offenses Definitions
The following definitions should be used when classifying Clery Act crimes and offenses. These
definitions are taken from the FBI’s Uniform Crime Reporting Handbook (UCR)
and the most recent
version of The Handbook for Campus Safety and Security Reporting.
Aggravated Assault: An unlawful attack by one (1) 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: include assaults or attempts to kill or
murder, poisoning (including the use of date rape drugs), assault with a dangerous or deadly weapon,
maiming, mayhem, assault with explosives, assault with disease (i.e., offender is aware he or she is
infected with a deadly disease and deliberately attempts to inflict the disease by biting, spitting, etc.).
Arrests: Persons processed by arrest, citation or summons, including:
1. Those persons arrested and released without a formal charge being placed against them. (An
arrest has occurred when a law enforcement officer detains an adult with the intention of seeking
charges against the individual for a specific offense(s) and a record is mare of the detention.)
2. Juveniles taken into custody or arrested by merely warned and released without being charged. A
juvenile should be counted as “arrested” when the circumstances are such that if the individual
were an adult and arrest would have been counted.
3. Any situation where a young person, in lieu of actual arrest, is summoned, cited or notified to
appear before the juvenile or youth court, or similar official, for a violation of the law.
4. Only violations by young persons where some police or official action is taken beyond a mere
interview, warning or admonishment.
Arson: Any willful or malicious burning or attempt to burn, with or without intent to defraud, a dwelling
house, public building, motor vehicle or aircraft, personal property of another, etc.
Burglary: 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 felony; breaking and entering with
intent to commit a larceny; housebreaking; safecracking; and all attempts at these offenses. Three (3)
conditions must be met to classify a crime as burglary:
1. There must be evidence of unlawful entry (i.e., trespass). This means the person did not have the
right to be in the structure at the time the incident occurred.
2. The unlawful entry must occur within a structure, which is defined as having four (4) walls, a roof,
and a door.
3. The structure was unlawfully entered to commit a felony or theft.
Disciplinary Referrals: The referral of any person to any official who initiates a disciplinary action of
which a record is established and which may result in the imposition of a sanction.
Drug Abuse Violations: The violation of laws prohibiting the production, distribution, and/or use of
certain controlled substances and the equipment or devices utilized in their preparation and/or use. The
unlawful cultivation, manufacture, distribution, sale, purchase, use, possession, transportation or
importation of any controlled drug or narcotic substance. Arrests for violations of state and local laws,
specifically those relating to the unlawful possession, sale, use, growing, manufacturing, and making of
narcotic drugs. The relevant substances include opium or cocaine and their derivatives (e.g., morphine,
heroin, codeine); marijuana; synthetic narcotics (e.g., Demerol, methadone); and dangerous non-narcotic
Revised 11/20/2020
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drugs (e.g., barbiturates, Benzedrine).
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 or her age or because of his or her temporary or permanent mental incapacity.
Incest: Sexual intercourse between persons who are related to each other within the degrees wherein
marriage is prohibited by law.
Liquor Law Violations: The violation of state or local laws or ordinances prohibiting the manufacture,
sale, purchase, transportation, possession, or use of alcoholic beverages, not including driving under the
influence and drunkenness.
Manslaughter by Negligence: The killing of another person through gross negligence. Any death
caused by the gross negligence of another (i.e., something a reasonable and prudent person would not
do). Note: “gross negligence” is the intentional failure to perform a manifest duty in reckless disregard of
the consequences as affecting the life or property of another.
Motor Vehicle Theft: The theft or attempted theft of a motor vehicle. Does not include thefts from a motor
vehicle. Classify as motor vehicle theft all incidents where automobiles are taken by persons not having
lawful access even though the vehicles are later abandoned, including joy riding.
Murder and Non-negligent Manslaughter: The willful (non-negligent) killing of one human being by
another. Any death caused by injuries received in a fight, argument, quarrel, assault, or the commission
of a crime. Note: do not include suicides, fetal deaths, traffic fatalities, accidental deaths, assaults with
intent to murder, attempts to murder, deaths by negligence, or justifiable homicides.
Rape: The penetration, no matter how slight, of the vagina or anus, with any body part or object, or oral
penetration be a sex organ of another person, without the consent of the victim. This offense includes the
rape of both males and females.
Robbery: 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. Essential elements:
committed in the presence of a victim (usually the owner or person having custody of the property); victim
is directly confronted by the perpetrator; victim is threatened with force or put in fear that force will be
used; and involves a theft or larceny. Includes both armed robbery and robbery where only personal
weapons (e.g., hands, fists, feet, etc.) are used.
Statutory Rape: Sexual intercourse with a person who is under the statutory age of consent. Note: the
statutory age of consent in Texas is 17.
Weapons: Carrying, Possessing, Etc.: The violation of laws or ordinances prohibiting the manufacture,
sale, purchase, transportation, possession, concealment, or use of firearms, cutting instruments,
explosives, incendiary devices, or other deadly weapons. This classification encompasses weapons
offenses that are regulatory in nature.
Violence Against Women Act (VAWA) Offenses
The following definitions should be used when classifying Violence Against Women Act (VAWA) crimes
and offenses. These definitions are taken from the
Violence Against Women Reauthorization Act of 2013
(VAWA).
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 existence of such a relationship shall be determined
based on the reporting party’s statement and with consideration of the length of the relationship, the type
Revised 11/20/2020
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of relationship, and the frequency of interaction between the persons involved in the relationship. Dating
violence includes, but is not limited to, sexual or physical abuse or the threat of such abuse. Dating
violence does not include acts covered under the definition of domestic violence.
Domestic Violence: A felony or misdemeanor crime 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; by a person
similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction in
which the crime of violence occurred; or by any other person against an adult or youth victim who is
protected from that person’s actions under the domestic or family violence laws of the jurisdiction in which
the violence occurred.
Stalking: Engaging in a course of conduct directed at a specific person that would cause a reasonable
person to fear for the person’s safety or the safety of others; or suffer substantial emotional distress.
“Course of conduct” means two (2) or more acts including, but not limited to, acts in which the stalker
directly, indirectly, or through third (3
rd
) parties, by any action, method, device, or means, follows,
monitors, observes, surveils, threatens, or communicates to or about a person, or interferes with a
person’s property. “Reasonable person” means a reasonable person under similar circumstances and
with similar identities to the victim. “Substantial emotional distress” means significant mental suffering or
anguish that may, but does not necessarily, require medical or other professional treatment or counseling.
Hate Crimes Definitions
A Hate Crime is defined for Clery Act reporting purposes as a criminal offense that manifests evidence
that the victim was intentionally selected because of the perpetrator’s bias against the victim. The
following definitions should be used when classifying Hate Crimes. These definitions are taken from the
FBI’s Uniform Crime Reporting Handbook (UCR) and the most recent version of
The Handbook for
Campus Safety and Security Reporting.
Aggravated Assault: An unlawful attack by one (1) 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: include assaults or attempts to kill or
murder, poisoning (including the use of date rape drugs), assault with a dangerous or deadly weapon,
maiming, mayhem, assault with explosives, assault with disease (i.e., offender is aware he or she is
infected with a deadly disease and deliberately attempts to inflict the disease by biting, spitting, etc.).
Arson: Any willful or malicious burning or attempt to burn, with or without intent to defraud, a dwelling
house, public building, motor vehicle or aircraft, personal property of another, etc.
Burglary: 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 felony; breaking and entering with
intent to commit a larceny; housebreaking; safecracking; and all attempts at these offenses. Three (3)
conditions must be met to classify a crime as burglary:
1. There must be evidence of unlawful entry (i.e., trespass). This means the person did not have the
right to be in the structure at the time the incident occurred.
2. The unlawful entry must occur within a structure, which is defined as having four (4) walls, a roof,
and a door.
3. The structure was unlawfully entered to commit a felony or theft.
Destruction/Damage/Vandalism of Property: To willfully or maliciously destroy, damage, deface, or
otherwise injure real or personal property without the consent of the owner or the person having custody
or control of it.
Revised 11/20/2020
Page 7 of 8
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 or her age or because of his or her temporary or permanent mental incapacity.
Incest: Sexual intercourse between persons who are related to each other within the degrees wherein
marriage is prohibited by law.
Intimidation: 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.
Larceny – Theft: 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.
Motor Vehicle Theft: The theft or attempted theft of a motor vehicle. Does not include thefts from a motor
vehicle. Classify as motor vehicle theft all incidents where automobiles are taken by persons not having
lawful access even though the vehicles are later abandoned, including joy riding.
Murder and Non-negligent Manslaughter: The willful (non-negligent) killing of one human being by
another. Any death caused by injuries received in a fight, argument, quarrel, assault, or the commission
of a crime. Note: do not include suicides, fetal deaths, traffic fatalities, accidental deaths, assaults with
intent to murder, attempts to murder, deaths by negligence, or justifiable homicides.
Rape: The penetration, no matter how slight, of the vagina or anus, with any body part or object, or oral
penetration be a sex organ of another person, without the consent of the victim. This offense includes the
rape of both males and females.
Robbery: 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. Essential elements:
committed in the presence of a victim (usually the owner or person having custody of the property); victim
is directly confronted by the perpetrator; victim is threatened with force or put in fear that force will be
used; and involves a theft or larceny. Includes both armed robbery and robbery where only personal
weapons (e.g., hands, fists, feet, etc.) are used.
Simple Assault: An unlawful physical attack by one (1) 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.
Statutory Rape: Sexual intercourse with a person who is under the statutory age of consent. Note: the
statutory age of consent in Texas is 17.
Type of Bias Definitions for Hate Crimes
When a Hate Crime is reported, the appropriate type(s) of bias must also be reported. The following
definitions of the eight (8) categories of bias which are reported under the Clery Act are taken from the
FBI’s Uniform Crime Reporting Handbook (UCR) and the most recent version of
The Handbook for
Campus Safety and Security Reporting.
Disability: A preformed negative opinion or attitude toward a group of persons based on their physical or
mental impairments, whether such disability is temporary or permanent, congenital or acquired by
heredity, accident, injury, advanced age or illness.
Ethnicity: A preformed negative opinion or attitude toward a group of people whose members identify
with each other, through a common heritage, often consisting of a common language, common culture
Revised 11/20/2020
Page 8 of 8
(often including a shared religion) and/or ideology that stresses common ancestry.
Gender: A preformed negative opinion or attitude toward a person or group of persons based on their
actual or perceived gender (e.g., male or female).
Gender Identity: A preformed negative opinion or attitude toward a person or group of persons based on
their actual or perceived gender identity (e.g., bias against transgender or gender non-conforming
individuals).
National Origin: A preformed negative opinion or attitude toward a group of people based on their actual
or perceived country of birth.
Race: A preformed negative attitude toward a group of persons who possess common physical
characteristics (e.g., color of skin, eyes, and/or hair; facial features, etc.) genetically transmitted by
descent and heredity which distinguish them as a distinct division of humankind (e.g., Asians, blacks or
African Americans, whites).
Religion: A preformed negative opinion or attitude toward a group of persons who share the same
religious beliefs regarding the origin and purpose of the universe and the existence or nonexistence of a
supreme being (e.g., Catholics, Jews, Protestants, atheists).
Sexual Orientation: A preformed negative opinion or attitude toward a group of persons based on their
actual or perceived sexual orientation.
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Completed 4 February 2021

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