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Campus Safety

Division of Safety & Operations

Clery Incident Report Form

If this incident has the potential to be an imminent or ongoing threat to the community, do not fill out this form. Call GW Emergency Services at (202) 994-6111 or 911 immediately.

Instructions: This form is for use by Campus Security Authorities and must be submitted any time a reportable incident is reported to you. This form will be used to track statistics in order to comply with federal law. 

Incident Class
A minor is defined as anyone under the age of 18. Click here to view Crime Classifications policy.
Location of Incident
Did the incident occur at a University sponsored activity or event?
If yes, describe what type of weapons
If yes, indicate agency to which the incident was reported
Was bias shown?
Check all that apply.
Was a minor involved?
A minor is defined as anyone under the age of 18. Click here to view the GW Protection of Minors policy.
Complainant / Victim Affiliation
Complainant / Victim Residency
Complainant / Victim Student Status
Relationship
Suspect / Assailant Affiliation
Suspect / Assailant Residency
Suspect / Assailant Student Status
To your knowledge, has the suspect / assailant been involved in other similar incidents?