This form is used to report safety or security incidents at Houston Christian University which ARE NOT of a sexual nature and do not potentially violate Title IX. For Title IX issues, please use the Title IX Reporting Form. Reporting Person Contact Information Reported By:* The Victim A Third Party If a third party reported the crime to you, please enter the relationship of the third party to the victim:*Name* First Last Phone*Email* Agency Notified If to your knowledge, a law enforcement agency was notified, please enter the name of that agency.Agency:Does the victim want the incident reported to law enforcement? Yes No Incident Information Location of the Incident* Building Name/Room Number Street Address City State ZIP Date of Incident* MM slash DD slash YYYY Time of Incident(If Known) : Hours Minutes AM PM AM/PM Incident Description*Please provide specific, detailed informationLocation What best describes the location for the crime?*(If the crime occurred in multiple places, check all that apply. Please see detailed description below.) On campus, residence hall On campus, not in a residence hall Public property inmediately adjacent to cmapus Non-campus in a University owned leased or controlled space (fraternity, sorority, off-campus classroom) Unknown location/ Other I do not know which category this would fall under. Geography Definition: On campus Any building or property owned or controlled by an institution within the same reasonably contiguous geographic area and used by the institution in direct support of, or in a manner related to, the institution’s educational purposes, including residence halls; and Any building or property that is within or reasonably contiguous to the area identified in paragraph (1) of this definition, that is owned by the institution but controlled by another person, is frequently used by students, and supports institutional purposes (such as food or other retail vendors) Geography Definition: Public Property All public property, including thoroughfares, streets, sidewalks, and parking facilities, that is within the campus, or immediately adjacent to and accessible from the campusGeography Definition: Non-campus building or property Any building or property owned or controlled by a student organization that is officially recognized by the institution; or Any building or property owned or controlled by an institution that is used in direct support of, or in relation to, the institution’s educational purposes, is frequently used by students, and is not within the same reasonably contiguous geographic area of the institution Please describe location to the best of your abilities:*Incident Category(Select to see definitions of offenses below) Homicide Sex Offense Aggravated Assault Motor Vehicle Theft Burglary Robbery Arson Dating Violence Domestic Violence Stalking Hate Crime Arrest for Liquor Law Violation Referral for Liquor Law Violation Arrest for Weapons Law Violation Referral for Weapons Law Violation Arrest for Drug Law Violation Referral for Drug Law Violation I am not sure how to classify this incident Other: If the crime was not listed above, please enter the additional crime category:*Homicide Murder/non-negligent manslaughter: the willful (non-negligent) killing of one human being by another Negligent Manslaughter: the killing of another person through gross negligence Sex Offense Any sexual act directed against another person without the consent of the victim, including instances where the victim is incapable of giving consent 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 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 Incest: Sexual intercourse between persons who are related to each other within the degrees wherein marriage is prohibited by law Statutory Rape: Sexual intercourse with a person who is under the statutory age of consent Motor Vehicle Theft The theft or attempted theft of a motor vehicleAggravated Assault Unlawful attack by one person upon another for the purpose of inflicting severe or aggravated bodily injury.Burglary Unlawful entry of a structure to commit a felony or a theftRobbery Taking or attempting to take anything of value from the care, custody, or control of a person or persons by force or threat of force or violence and/or by putting the victim in fearArson Willful or malicious burning or attempt to burn with or without intent to defraud a dwelling house, public building, motor vehicle or aircraft, personal property of another, etc.Dating Violence Violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim; and where the existence of such a relationship shall be determined based on a consideration of the following factors: •the length of the relationship •the type of the relationship •the frequency of interaction between the persons involved in the relationshipDomestic Violence Felony or misdemeanor crimes of violence committed by a current or former spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner, by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction…or by any other person against an adult or youth victim who is protected from that person’s acts under the domestic or family violence laws of the jurisdictionStalking 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 Arrest for Liquor Law Violation The violation of state or local laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, or use of alcoholic beveragesReferral for Liquor Law Violation The violation of state or local laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, or use of alcoholic beveragesArrest for Drug Law Violation The violation of laws prohibiting the production, distribution and/or use of certain controlled substances and the equipment or devices utilized in their preparation and/or useReferral for Drug Law Violation The violation of laws prohibiting the production, distribution and/or use of certain controlled substances and the equipment or devices utilized in their preparation and/or useArrest for Weapons Law Violation The violation of laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, concealment, or use of firearms, cutting instruments, explosives, incendiary devices, or other deadly weaponsReferral for Weapons Law Violation The violation of laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, concealment, or use of firearms, cutting instruments, explosives, incendiary devices, or other deadly weaponsIs there any evidence that this crime was motivated by bias?* Yes No If yes, please choose any/all categories of prejudice that apply.* Race Gender Ethnicity Religion Disability National Origin Gender Identity Sexual Orientation Please provide a brief summary of the evidence supporting a bias motivation:*
