Campus Crime Report Form According to the Higher Education Act, or 20 U .S.C. 1092 now known as the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, the University of Mary Washington must collect certain campus crime statistics. This law applies to certain crimes reported to the police and other campus officials. The details of this report will not be made public. Only the number of crimes occurring will be released. Your name will not be released. It is not required for the report, but it will help ensure the crime is not counted twice.Date * Required MM slash DD slash YYYY Time * Required : Hours Minutes AM/PM AM PM AM/PM LocationPlease give building name, parking lot number, street name with cross streets or close address, or nearby buildings if it occurred outside. Use a UMW campus map and circle location if necessary. Crime Reported: Murder Burglary Forcible Sex Offense Liquor Violation Simple Assault (only applies to hate crime reporting) Manslaughter Motor Vehicle Theft Non-forcible sex offense Drug Violation Robbery Aggravated Assault Arson Weapon Violation Arrested for: Liquor Violation Drug Violation Weapon Violation Disciplinary Referral Reported: Liquor Violation Drug Violation Weapon Violation To whom disciplinary action was referred?Head Count for Liquor/Drug/Weapon Violations:Hate crime? Yes No Based on: Race Gender Religion Sexual Orientation Ethnicity Disability Location Classification: On-campus Residence Hall Non-campus Public Property Law Enforcement Agency(s) the incident has been reported to: None University of Mary Washington Police Department City of Fredericksburg Police Department Stafford County Sheriff’s Office King George County Sheriff’s Office Other Please specify:Police Report Number:Please give a brief description of the crime to help us classify it (use back of page if necessary):Reporting Department:Date MM slash DD slash YYYY Name of Departmental Official submitting this form:Phone:Email Enter Email Confirm Email Once you submit this form, it will be sent to us, and an email copy will be sent to you to keep for your records. If you have questions about classifying a crime or a location, contact the UMW Police Department at 540-654-1025. Δ