"Campus Security Authority" Crime Report

According to the Higher Education Act, or 20 U .S.C. 1092 now known as the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, the Texas A&M University-Texarkana must collect certain campus crime statistics. This law applies to certain crimes reported to the police and other campus officials.

The details of this report will not be made public. Only the number of crimes occurring will be released. Your name will not be released. It is not required for the report, but it will help ensure the crime is not counted twice.

Report Information

Date of Crime:   / /      Time of occurrence:  :

Location of Crime:  
Please give building name, or nearby buildings if it occurred outside.

Crime reported:
 Murder   Manslaughter   Robbery   Burglary   Motor Vehicle Theft
 Aggravated Assault   Forcible Sex Offense   Non-Forcible Sex Offense
 Arson   Liquor Violation Drug Violation   Weapon Violation

 Simple Assault (only applies to hate crime reporting)

Disciplinary referral reported:
 Liquor Violation   Drug Violation   Weapon Violation

To Whom disciplinary action was referred?:  

Head Count for Liquor/Drug/Weapon Violations?:  

Hate Crime?   Yes No

Based on:
 Race   Gender   Religion    Sexual Orientation   Ethnicity Disability

Location Classification:   On-Campus Non-Campus Public Property

Law Enforcement Agency(s) the incident has been reported to:
 None   A&M Texarkana Police Department   Texarkana, Tx Police Department

Police Report Number if known:  

Name of CSA submitting this form:  

Phone Number:  

Email Address:  

Please give a brief description of the crime to help use classify it:


This form will be submitted to the A&M Texarkana Police Department. If you have questions about classifying a crime or a location, contact Chief John Gann at 903-223-3114 or Officer Alex Serrano at 903-334-6611

State law requires that you be informed of the following: (1) you are entitled to request to be informed about the information about yourself collected by use of this form (with a few exceptions as provided by law); (2) you are entitled to receive and review that information; and (3) you are entitled to have the information corrected at no charge to you. For more information see our Privacy Statement.