Do Not provide name/contact information if the person reporting the incident requests confidentiality.

The Campus Security Authority (CSA) is to document as much of the requested information on the form, excluding identity if confidentiality is requested, as s/he knows. The awareness can come from a direct report from a student or staff member or from a third party. Campus Police will use the submitted information to verify the appropriate classification of the crime.

The college 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 Chief Harris: 540-857-7797 or charris@virginiawestern.edu.

Note: Please complete all relevant fields.

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