The Campus Security Authority (CSA) is to document as much of the requested information on the form, excluding identity if confidentiality is requested, as available to the reporter. The awareness can come from a direct report from a student or staff member or from a third party. University Police will use the submitted information to verify the appropriate classification of the crime. This form should be completed and submitted without delay.

The University has made many resources available to victims/witnesses of crime at no cost. If you would like to learn more about these resources, have any questions, or would like assistance completing this form please contact the Compliance Coordinator or University Police, at (906) 227-2151. You may also find further information by visiting

Note: Please complete all relevant fields. Required fields are marked with an asterisk (*).

CSA Contact Information

Incident Details



Check below if the date the incident occurred is unknown

Please provide specific, detailed information related to the reported incident(s).

Incident Category

(select all that apply)

Non-negligent manslaughter; and negligent manslaughter (including vehicular manslaughter).

Unlawful attack upon another with intent to inflict severe injury or great bodily harm.

If rape or fondling, were the victim and the offender acquainted (did they know each other)?

Unlawful entry into a structure to commit a felony or theft.

Taking or attempting to take something by force; violence; threat; or by putting victim in fear.

Theft of automobiles; trucks; etc.; including "joyriding" (taking by person without lawful access).

Willful or malicious burning / attempt to burn structure; vehicle; or personal property of another.

Violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim.

Domestic violence is violence committed by a current or former spouse; intimate partner of the victim; person with whom the victim shares a child in common; current or former cohabitant who lived as a spouse or intimate partner with the victim; a person who, by law, is similarly situated to a spouse of the victim; or any other person against an adult or youth victim who is protected from that person's acts under the domestic or family violence laws in the jurisdiction where the crime of violence occurred.

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.

If the incident was a liquor, drug or weapon law violation, please indicate if the incident involved an arrest (any individual) or if the violation resulted in a student disciplinary referral instead of an arrest:

(A) Liquor Underage possession or consumption; distribution to minors
(B) Drug Use; possession or distribution of controlled substances or possession of drug paraphernalia
(C) Weapon Law Possession or use of an illegal weapon
If crime not listed above, please enter new crime category.
If, to your knowledge, a law enforcement agency was notified, please enter the name of that agency.

Reported By

Who reported the crime to you

Was the crime reported to you by the victim, a third party, or both? If so, choose one or both.

If a third party reported the crime to you, please enter the relationship of the third party to the victim.
Do not enter if confidentiality is requested.
Do not enter if confidentiality is requested.

Incident Location

What best describes the location of the crime?
If the crime occurred in multiple places, check all that apply.
If known, provide specific occurrence location (building name, street address, office number, etc.).

Bias & Prejudice

Is there evidence that this crime was motivated by bias?
Prejudice Category

Please choose any/all potential categories of prejudice.

Please provide a brief summary of the evidence supporting a bias motivation.


Once completed, you may submit this form electronically by clicking on the Submit button below. For issues with this form, please contact:

  Northern Michigan University
  Police Department Service Building
  2073 Sugarloaf Ave
  Marquette MI 49855
  Phone: 906-227-2151 (non-emergency)