CLERY INCIDENT REPORT FORM

Campus Security Authority
One purpose of Clery is to encourage reporting and the accurate collection of campus crime statistics to promote crime awareness and to enhance campus safety through reliable statistical records. The purpose of this report form is to provide a uniform procedure for documenting the what, when and where of certain reportable crimes and/or non-criminal hate incidents having been reported to a campus security authority (CSA) other than the Campus Safety Department.

No victim personal identifying information shall be included on this form. The intention of this form is to increase public safety.
It is the policy of NEO A&M College to encourage victims and/or witnesses to crime(s) to report such crime(s) to the department of public safety and/or to a designated Campus Security Authority(CSA). (A list of CSAs is available on the NEO DPS website) For the purpose of Clery the CSAs are required to document certain reportable crimes and non-criminal hate incidents which have been reported to them and which have occurred in:
1. On-campus property: Any building or property owned or controlled by the college within the same reasonable contiguous geographic area and used by the College, used in direct support of, or in a manner related to the College's educational purpose, including buildings or property the location described herein that is owned by the College but controlled by another person and which is frequently used by students (excluding residential life buildings)
2. On-campus residential life buildings: residential life buildings, including those of officially recognized organizations in which the students live, within one mile of campus.
3. Non-campus property: non-campus property or building owned or controlled by the College that is frequently used by students and is not within the same reasonable contiguous geographic area (one mile) of the College, or any building/property that is owned or controlled by a student organization that is officially recognized by the College.
4. Public property: public property located immediately adjacent to and accessible from campus, including thoroughfares, sidewalks, streets, lands, and parks.
For Clery purposes, whether an offender or victim is a student is not relevant. Clery documentation is not satisfied by simply directing/referring the reporting part to the NEO Department of Public Safety. To satisfy reporting requirements for the Clery Act, all CSAs are required to complete this form when any of the specified offenses listed below are reported to them. nonetheless, a person reporting a crime shall also be encouraged to report the crime to the NEO Department of Public Safety.

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Crime Category

Crime Category Homicide Manslaughter Sex Offense (rape) Sex Offense (fondling) Sex Offense (incest) Sex Offense (stat. rape) Robbery Aggravated Assault Burglary Motor Vehicle Theft Domestic Violence Dating Violence Stalking Arson Liquor Law Violation Drug Law Violation Weapons Violation
Location of Occurrence

Location of Occurrence On-campus (excluding residential) On-campus (residential life building) Non-campus Property Public Property Unknown
Date of Incident
Time of Incident
CSA Incident #
Date Reported
Time Reported
NEO PD Report # (if applicable)
Name of CSA Receiving report
NEO Department receiving report
Number of arrests
Number of referrals
Reporting Party

Reporting Party Victim Witness Other
Location/address of incident (non-victim identifying):
Brief description of crime or incident
Title IX

Title IX Yes No
Date Reported to Title IX coordinator
Hate Crime Type (if applicable)

Hate Crime Type (if applicable) Bodily injury Telephone Vandalism Message Email Other
Category of Bias

Category of Bias Ethnicity Race Religion Gender Disability National Origin Sexual Orientation Gender Identity
Sex Offense: Sex offenses are of special concern to the campus community because they have been historically under reported. The victim of a sex offense typically desires confidentiality and anonymity, as a result he/she will often seek a reporting source other than law enforcement such as a designated Campus Security Authority (CSA). Because the sex offender may continue to pose a threat to the community, the threat potential needs evaluated, and the campus community alerted/warned as necessary. In this regard, the following additional information is requested. Because of the seriousness of this crime, this will be immediately reported to proper authorities.

Sex Offense: Sex offenses are of special concern to the campus community because they have been historically under reported. The victim of a sex offense typically desires confidentiality and anonymity, as a result he/she will often seek a reporting source other than law enforcement such as a designated Campus Security Authority (CSA). Because the sex offender may continue to pose a threat to the community, the threat potential needs evaluated, and the campus community alerted/warned as necessary. In this regard, the following additional information is requested. Because of the seriousness of this crime, this will be immediately reported to proper authorities. Known Offender (friend, classmate, acquiantance, date, etc. OSU affiliated (student, staff or faculty) Unknown offender (stranger) Victim was not injured (excluding emotional psychological trauma)
If victim was injured - describe injuries
Was alcohol involved:

Was alcohol involved: offender victim
Were narcotics involved

Were narcotics involved offender victim
Were weapons involved

Were weapons involved Yes No
Definitions:

TCriminal Homicide/Murder: The willful (non-negligent) killing of a human being by another.
Manslaughter: The killing of another person through gross negligence.
Sex Offense:
a. Rape – the penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.
b. Fondling - the touching of the private body parts of another person for the purpose of sexual gratification, without the consent of the victim, including instances where the victim is incapable of giving consent because of his/her age or because of his/her temporary or permanent mental incapacity.
c. Incest – non-forcible sexual intercourse between persons who are related to each other within the degrees wherein marriage is prohibited by law.
d. Statutory rape - non-forcible sexual intercourse with a person who is under the statutory age of consent.
Robbery: The taking of personal property in the possession of another, from his/her immediate presence and against his/her will, accomplished by means of force or fear. (includes attempts)
Aggravated Assault: An unlawful assault upon the person of another for the purpose of inflicting severe or aggravated bodily injury (includes attempts and whether or not an injury occurred)
Motor Vehicle Theft: The taking of a motor vehicle (as defined) without the consent of the owner with the intent to either permanently or temporarily deprive the owner of the vehicle (includes attempts)
Arson: The willful or malicious burning or attempt to burn (without the intent to defraud) a dwelling, house, public building, motor vehicle or aircraft, or personal property of another (includes attempts)
Drug/Narcotics Violation: The unlawful possession, sale, use, transportation, cultivation, manufacturing, maintaining in an unlawful place (CSAs are only required to record and report this offense when the person was referred for campus disciplinary action)
Liquor Law Violations: The unlawful possession, sale transportation, manufacturing, furnishing alcohol to a minor (under the age of 21 years) or maintaining an unlawful drinking place. Clery does not require the reporting of public drunkenness or driving while under the influence offenses. (CSAs are only required to record and report this offense when the person was referred for campus disciplinary action)
Weapons offense: The unlawful possession or control of any firearm, deadly weapon (including nunchakus or billy club) illegal knife or explosive device while on the property of Northeastern Oklahoma A&M College except as required in the lawful course of business or as authorized by the NEO A&M Department of Public Safety. (CSAs are only required to record and report this offense when the person was referred for campus disciplinary action.)
Hate crime: A criminal ac involving one/more of the listed crimes which was motivated by bias against any person or group of persons, or the property of any person or group of persons because of the ethnicity, race, national origin, religion, gender, sexual orientation, gender identity, or disability of the person or group or bias based upon the perception that the person or group has one or more of those characteristics.
VAWA Act: In 2013, new areas of reporting include domestic violence, dating violence, and stalking.
a. Dating violence – dating violence is committed by a person who is or has been in social relationship of a romantic or intimate nature with another person. The existence of such relationship shall be determined based on the reporting party’s statement and with consideration of the length of the relationship, the type of relationship, and the frequency of interaction between the persons involved in the relationship. Dating violence includes but is not limited to sexual or physical abuse or the threat of such abuse. Dating violence does not include acts that meet the definition of domestic violence.
b. Domestic violence – domestic violence is a felony or misdemeanor crime of violence committed by a:
• Current or former spouse or intimate partner of the victim
• Person with whom the victim shares a child in common
• Person who is cohabitating with or has cohabited with the victim as a spouse or intimate partner.
• Person similarly situated to a spouse of the victim under the domestic or family violence laws of Oklahoma, or
• Any other person against an adult or youth victim who is protected from the person’s acts under the domestic of family violence laws of Oklahoma
c. Stalking – engaging in a course of conduct directed at a specific person that would cause a reasonable person to fear for his or her safety or the safety of others or suffer substantial emotional distress.
Definition of Campus Security Authority (CSA)

a. A department of public safety/campus police of the college
b. Any individual who has responsibility for campus security but who is not a member of the department of public safety
c. Any individual specified in the University’s statement of campus security policy as an individual to which students and employees should report criminal offenses.
d. An individual of the College who has significant responsibility for student and campus activities (e.g. housing, student discipline, athletics directors/coaches)
Submit Report by clicking submit below. The Report can also be submitted by:

Delivering to the Northeastern Oklahoma A&M College Department of Public Safety 915 4th Ave. NE Miami, OK 74354, mail it to PO Box 3992 attn: Department of Public Safety or email it to Nathan.bartlett@neo.edu. If the report involves a sex offense, a copy of the report should also be sent to student discipline and Title IX. Any questions concerning this form or the Clery Act should be directed to the Department of Public Safety.
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CLERY INCIDENT REPORT FORM

CLERY INCIDENT REPORT FORM

No victim personal identifying information shall be included on this form. The intention of this form is to increase public safety.

Definitions:

Definition of Campus Security Authority (CSA)

Submit Report by clicking submit below. The Report can also be submitted by: