Clery Act Crime Survey Form

Section A: Introduction

The Clery Act applies to certain crimes (see Clery Act Crime Categories) occurring on University property (see Clery Act Reportable Locations) reported to the police (either UNL Police Department or another law enforcement agency) and/or University officials known as Campus Security Authorities (CSA). CSA’s are mandated crime reporters per the Clery Act. As such, CSA’s shall report, on a timely basis or upon request, any Clery-defined crimes to which they become aware to the University’s Accreditation/Compliance Manager (ACM)*, who will use the submitted information to verify the appropriate classification of the crime per the Clery Act. As such, it is important to provide sufficient incident detail to allow for this determination. The purpose of this form is to capture the required information as completely and easily as possible. Please see Campus Security Authorities for additional information on CSA functions and responsibilities.

Anonymity/confidentiality – If a reporting party requests anonymity or confidentiality, this request must be honored to the extent permitted by law. Accordingly, no information should be included on this form that would personally identify the victim without his/her consent.

Submission – To send the completed report electronically, please click the "Submit" button at the end of this form. You may also print this form and either fax (402-472-7972), mail to UNL Police Department (300 N. 17th St, Lincoln, NE 68588 – Attention: Accreditation/Compliance Manager), or email to

*This requirement is only applicable for crime reports to CSAs that have not been forwarded to the UNL Police Department (i.e. the victim clearly does not want law enforcement notified).

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