Clery Report Form
NOTE: If you need IMMEDIATE ASSISTANCE call the University Police directly at 911 from any campus phone or 256.765.4357. This form generates a report that is normally reviewed during business hours and should not be used if you need an immediate response.
The form below is intended for the sole use of those persons designated as Campus Security Authorities [CSA] at and for the University at Albany as required unde the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, [Clery Act] codified at 20 USC 1092 (f) as a part of the Higher Education Act of 1965. All reports made through this form will be confirmed by contacting the CSA reporting the incident.
This form is to be used when a CSA has received information regarding an incident that they, in good faith, believe to be a reportable offense under the Clery Act and where the victim does not wish to report the incident to the police. Please fill in all of the fields below. Please be as complete as possible to provide the University with the best opportunity to respond to this incident.
Information on the reporting requirements may be found in the Handbook for Campus Crime Reporting. Information specific to the duties of Campus Security Authorities may be found in chapter 4 of the Handbook.
In all cases the person reporting the incident to the Campus Security Authority may choose to withold their identity.