1. Campus Security Authorities Incident Reporting Form Instructions

2. Incident Report Form – when to complete????? Become aware of a crime Become aware of a crime Direct report from a student or staff member or a third party Direct report from a student or staff member or a third party Complete even if the person making the report tells you that the crime has been reported to a police agency Complete even if the person making the report tells you that the crime has been reported to a police agency

3. Instructions on completing the Incident Report Form If this is a confidential report, please indicate whether you are a: Choose an item. Drop down selection will be   Professional Counselor   Medical Professional Name of Campus Security Authority s completing this report form: First NameLast Name Phone Date of Incident

4. Continue….instructions on completing the Incident Report Form Of Incident Description Of Incident Does The Victim Want To Remain Anonymous?. Choose an item. Drop down selection will be Yes No

5. If No, please provide name and contact information. First Last Contact Information Continue instructions on completing the Incident Report Form

6. Definitions of Crimes Type of Incident (Definitions of each incident below) Drop down selection box will be the yellow highlighted crimes: Homicide - Murder, non-negligent manslaughter, and negligent manslaughter (including vehicular manslaughter). Aggravated assault - unlawful attack upon another with intent to inflict severe injury or great bodily harm. Burglary - unlawful entry into a structure to commit a felony or theft. Robbery – taking/attempting to take something by force, violence, threat, or by putting victim in fear.

7. Definitions of Crimes Motor vehicle theft - theft of automobiles, trucks, etc., including “joyriding” (taking by person without lawful access). Arson - willful or malicious burning/attempt to burn structure, vehicle, or personal property of another. Liquor, drug, and weapon law violations – underage possession/consumption; distribution to minors; use, possession, or distribution of controlled substances; possession or use of an illegal weapon. Hate Crimes – the above listed crimes fall under hate crimes along with larceny, theft, simple assault, intimidation and destruction of property, when victim intentionally selected due to race, gender, sexual orientation, ethnicity, disability, national origin or gender identity. Choose an item Drop down selection will read LarcenySimple AssaultDestruction of Property TheftIntimidation.

8. Hate Crimes. If there is evidence that this crime was motivated by hate or bias, please identify the potential category or prejudice? Choose an item. (Check all that apply) RaceGenderSexual Orientation EthnicityDisabilityNational Origin Gender Identity If the crime was motivated by hate or bias, please provide a brief summary of evidence supporting a hate motivation:

9. Sex Offenses- forcible sexual act directed against another person, forcibly and/or against that person’s will; or not forcibly or against the person’s will where the victim is incapable of giving consent.. Choose an item. Drop down selection box will read Forcible Rape Forcible Sodomy Sexual Assault with an Object Forcible Fondling None of the above

10. Definitions - Sex Offenses. Forcible Rape - the carnal knowledge of a person, forcibly and/or against the person’s will; or not forcibly or against the person’s will where the victim is incapable of giving consent because of his/her temporary or permanent mental or physical incapacity (or because of his/her youth). Forcible Sodomy - oral or anal sexual intercourse with another person, forcibly and/or against that persons will; or not forcibly against the person’s will where the victim is incapable of giving consent because of his/her youth or because of his/her temporary or permanent mental or physical incapacity.

11. Cont. Definitions - Sex Offenses. Sexual Assault with an Object - the use of an object or instrument to unlawfully penetrate, however slightly, the genital or anal opening of the body of another person, forcibly and/or against that person’s will; or not forcibly or against the persons will where the victim is incapable of giving consent because of his/her youth or because of his/her temporary or permanent mental or physical incapacity. Forcible Fondling - the touching of the private body parts of another person for the purpose of sexual gratification, forcibly and/or against that person’s will; or, not forcibly or against the persons’ will where the victim is incapable of giving consent because of his/her youth or because of his/her temporary or permanent mental incapacity.

12. Sex Offenses – non forcible unlawful, non-forcible sexual intercourse.. Choose an item. Drop down selection box will read Incest Statutory Rape Domestic Violence Dating Violence Stalking None of the above

13. Definitions - Sex Offenses – non forcible unlawful, non-forcible sexual intercourse. And Violence Against Women Act.. Incest - non-forcible sexual intercourse between persons who are related to each other within the degrees wherein marriage is prohibited by law. Statutory Rape - non-forcible sexual intercourse with a person who is under the statutory age of consent. Violence Against Women Act Domestic Violence - felony or misdemeanor crimes of violence committed by a current or former spouse of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabited with the victim, as a spouse, by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction received grant monies, or by any other person against an adult or youth victim who is protected from that person’s acts under the domestic or family violence laws of the jurisdiction.

14. Cont. Definitions - Sex Offenses – non forcible unlawful, non-forcible sexual intercourse. And Violence Against Women Act.. Dating Violence - committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim; and where the existence of such a relationship shall be determined based on a consideration of the following factors; the length of the relationship, the type of relationship; the frequency of interaction between the persons involved in the relationship. Stalking - 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 other; or suffer substantial emotional distress.

15. Please answer the following if the incident was a sex offense. Was the crime committed forcibly and/or against the victim’s will?  Yes  No  Unknown Was the victim incapable of giving consent because of temporary or permanent mental or physical incapable of giving consent because of temporary or permanent mental or physical incapacity (or because the victim is below the age of consent)?  Yes  No  Unknown Is there evidence that the assault was facilitated by administration of drugs or alcohol?  Yes  No  Unknown

16. Continue-Please answer the following if the incident was a sex offense. If you checked “yes” to the previous questions, please explain.

17. Continue-Please answer the following if the incident was a sex offense. Was the incident reported to you by the victim, the offender, or a third party? Choose an item. Drop down selection box will read. Victim Offender Third Party Location of incident: (building name, street address, etc.) is known, please provide it.  On-Campus, resident halls  On-Campus, not in residence halls  Off-Campus, public property immediately adjacent to campus (sidewalks, streets adjacent to campus)  Off-Campus, NOT affiliated with and not adjacent to campus  At an unknown location

18. Has this been reported to Lock Haven University Title IX Coordinator? Choose an item. Drop down selection box will read. Yes No Continue-Please answer the following if the incident was a sex offense.