Clery Reporting Form Name Department Were any crimes reported to you during the requested calendar year? No Yes Reporting Person Phone Number (with area code) Classification See classification definitions Date Incident Occurred Location of Incident (building name or address) Incident Description Did you report the incident to Campus Public Safety? No Yes Did you report the incident to other Public Safety Authority? No Yes Did the crime occur on LCC owned, controlled, or leased property? No Yes I don't know Did the crime occur at a College-sponsored activity or event? No Yes Did the crime occur in a building or on the street? Building Street Building Street If a hate (bias) related crime was reported to you, please fill out the top section of Page 1 and then complete the following information about the type of bias involved in the crime. Hate/Bias Race Religion Ethnicity Gender Sexual Orientation Disability See types of hate / bias crimes Contact Information: Name Campus Extension Off-Campus Phone Number E-mail Address Leave this field blank