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Clery Reporting Form Information

This form is not for emergency crime reporting, please dial 911 if you or someone else is in immediate danger (9-911 on campus). Please read the directions and see the form at the bottom of this page.

The purpose of the Clery Crime Reporting Form is to collect unreported crime information and referral statistics (as required by federal law) to inform UWO and the public of unreported crimes. Not all crime victims/survivors choose to report to the University or to law enforcement but may still want their crimes counted or acknowledged in crime statistics. Collecting all crime information assists UWO in identifying and creating prevention programming and services in response to crime patterns, and to gather and disclose crime information accurately and promptly for Timely Warnings and in the UWO Annual Security and Fire Safety Report.

This form is for victim anonymous Clery crime reporting (confidential resources, students, guests, parents/guardians).

If you are a victim of a crime and wish to report an incident without your name, please check the box, “I am reporting anonymously as the victim/survivor” instead of putting in your name. If you would like help with this form or to access support services, please contact one of the campus confidential resources listed on the Title IX web page (

If the victim/survivor does not need to remain anonymous, please call the UWO Police at 920-424-1212 to report a non-emergency crime or use the Report an Incident Form.

**UWO employees who are not Title IX Confidential Resources must report sexual misconduct on the official Title IX Report Form-do not also report the same incident on this Clery form. Go to the Title IX web page,

This form WILL NOT result in a University or police response or investigation, with the exception it is determined from the information submitted, there is or may be an on-going threat to individuals or the UWO community. UWO Clery personnel/UWO Police may have to follow-up with UWO employees for more information to be able to report UWO crime statistics accurately.

If you have witnessed, heard about, or experienced one of the crimes listed on the UWO Police Department’s Clery & Safety web page, on any UWO campus, please report it here IF YOU HAVE NOT already reported it to the UWO Police Department, Dean of Students Office, Human Resources, or Equal Opportunity, Equity & Affirmative Action or on the official Title IX Report Form.

If you are an UWO employee or anyone else other than the victim/survivor filling out this form, please put your contact information. The anonymity of this report form belongs to the victim/survivor, but UWO guests, students, and parents/guardians may also leave out their identity and contact information.

Clery Reporting Form

Victim/Survivor Rights and Resources Sheet