Confidential Crime Report Form

Federal and state laws require Transylvania to report any disclosures of crime committed on our campus and sexual misconduct that occurs involving our students on or off campus.  Therefore, when an incident is disclosed to you, we ask that you complete the following form so that we have record of the incident.  These reports are confidential and do not have to include identifiable information about the individual.  Reports may either be filled out with the individual or after the individual has left your office, but it is the responsibility of the Transylvania employee to fill out the form. 

Again, this report is completely confidential and is sent only to the Dean of Students.


Instructions:

1. This form is intended for use in cases of crime committed on our campus and sexual misconduct that occurs involving our students on or off campus.
2. Do not include the victim/survivor’s name or other identifying information on this form without consent of the victim/survivor.
3. Record as much requested data as possible based on information volunteered or discussed. Do not pry for information, just list the information obtained in the conversation.
4. Complete this form even if the victim/survivor indicates that he or she has spoken with another person on-campus and even if you will be referring the victim/survivor to another department.