Campus Security Authority Crime Report Form

Contact Information Required
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Incident Description Location of Incident: Required


Did the crime occur in a building or on the street? Did the crime occur in a building or on the street?: Required



Did the crime occur on a UW owned, controlled, or leased property?: Required


Did the crime occur at a University-sponsored activity or event?: Required


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Incident Classification. Select all that apply to this incident: Required




















Has the incident been reported to another UW department or to police?:

Offender(s) known?:

Were the victim and suspect ever living together, related or in a dating relationship?:

Was the incident motivated by bias (i.e., hate crime)?:

If motivated by bias, please select all biases that were relevant.:






STOP! This form is solely for use by Campus Security Authority to report incidents occurring on-campus, non-campus UW owned property or public property adjacent to on-campus properties.

Did You Know?

Nine out of 10 of UW Bothell students are from the state of Washington.