INCIDENT REPORT

THIS FORM SHOULD NOT BE USED TO REPORT AN EMERGENCY OR IMMEDIATE THREAT TO SAFETY. IF YOU ARE EXPERIENCING AN EMERGENCY, CALL FMU CAMPUS SAFETY AT 305-626-3771 OR THE LOCAL POLICE AT 911.

Please provide as much information as you can and feel comfortable sharing. If you do not know or have information, just leave it blank. If you prefer to meet with the Title IX Coordinator to ask questions and share information in person, you can just fill in your contact information below and you’ll receive a phone call or email to discuss the reporting process and your options. NOTE: If you want to remain anonymous, do NOT include your name or other contact information. Although anonymous submissions are accepted, an anonymous report may limit our ability to gather critical information and follow up with you.

It is the policy of Florida Memorial University to encourage victims and/or witnesses to crime(s) to report such crimes to the FMU Campus Safety and/or a designated authority.

Incident Report Form
Questions marked by * are required.
Type of Incident:

  • Homicide
  • Manslaughter
  • Aggravated Assault
  • Sex Offense (Forcible)
  • Burglary
  • Motor Vehicle Theft
  • Alcohol Violations
  • Drug/Narcotic Violations
  • Other
Hate Crime (Type):

  • Bodily Injury
  • Telephone
  • Vandalism
  • Message
  • Email
  • Other
Category of Prejudice:

  • Ethnicity
  • Race
  • Religion
  • Disability
  • National Origin
  • Sexual Orientation
Location of Incident:

  • On-Campus (Excluding residential life)
  • On-Campus (Residential life buildings)
  • Public Property
  • Unknown
Date of Incident:
Time of Incident:
Reporting Party:

  • Victim
  • Witness
Police Report Filed?

  • Yes
  • No
Date Filed:
Campus Safety Case #:
Known Offender:

  • Friend
  • Classmate
  • Acquaintance
  • Date
FMU Affiliated:

  • Student
  • Staff
  • Faculty
Victim Injured?

  • Victim was not injured (excluding emotional/psychological trauma)
Alcohol Involved:

  • Offender
  • Victim
Drugs Involved:

  • Offender
  • Victim
Narcotics Involved:

  • Offender
  • Victim
Weapon Involved:

  • Yes
  • No
Race:
Gender:

  • Male
  • Female
Age:
Height:
Weight:
Hair Color:
Eye Color:
Physical Characteristics:
Brief Description of Crime or Incident: