Campus Security Authority Incident Form

This information is provided to meet the requirements of the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act of 1998 and the Kentucky Postsecondary Education Campus Security (Minger) Act of 2000. Submission of this report does not constitute an official Police Report and will not result in any further investigation by law enforcement personnel unless the reported act is an immediate threat to the safety or well-being of a student or the University community.

CSA Information

This is the date the incident was reported to you.

Time the incident was reported to you. 

Incident Information

Be specific. Include information such as whether the incident occurred inside the building or outside the building, etc.