CSA Reporter & Incident Background Information

Campus Security Authority Report Form

Full Name of CSA Reporter(Required)

Full name

Phone Number of CSA Reporter(Required)

Email Address of CSA Reporter(Required)

UM-Flint Affiliation of CSA(Required)

UM-Flint Affiliation of CSA

Date of incident(Required)

Time of incident(Required)

Location of Incident(Required)

Specific location(Required)

Specific location

Did the incident occur on property owned, controlled, or leased by the College or College-affiliated organization?(Required)

Did the incident occur at a College-sponsored activity or event?(Required)