Student Judicial Affairs

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Off-Campus Incident Report Form

Type

Party House Complaint
Other

SCPD Case #

UCPD Case #

Other Law Enforcement Agency

Case #

Incident Date

Incident Time

Incident Address

Landlord Name and Contact Info

First and Last Name

Address

Phone

Email

Landlord Notified

Yes
No

Incident Narrative

Student Information

# UCSC Students Tenants Present

First and Last Name	Date of Birth	Phone

UCSC Student Organization Involved

Yes
No

If yes, Provide the Name of Organization

Police Information

# UCSC Police Officers Responded

Officer Name(s)

# SCPD Officers Responded

Officer Name(s)

Address Flagged Priors

Yes
No

If YES, Date(s)

SCPD Case #'s

Incident Detail

Audible from the Street

Yes
No

Distance

Feet

Estimated # Guests

Alcohol Present

Yes
No

Keg

Yes
No

Drugs Present

Yes
No

Amplified Sound

Yes
No

Cited for

9.36.010 - Curfew - Offensive Noise

9.36.020 - Unreasonably disturbing noises

9.37.010 - Loud and Unruly Gatherings and "Party Ordinance"

9.37.020 - Resp. to Loud and Unruly Gathering

9.37.060 - Service of Alcoholic Beverages to Minors

9.40 - Sound Amplifications

Other

» View City of Santa Cruz Municipal Code Sections or go to City of Santa Cruz Website.

Witnesses/Victims/Complainant(s) Identified?
Yes
No
If yes, provide info below

Witnesses/Victims/Complainant(s)

First and Last Name

Phone

Address

Email

First and Last Name

Phone

Address

Email

First and Last Name

Phone

Address

Email

First and Last Name

Phone

Address

Email

First and Last Name

Phone

Address

Email

Submitted By

First and Last Name

Phone

Address

Email

Requested action

Have Director, Student Judicial Affairs contact me

Information Only, No Action Requested

Action Requested

I have contacted

Santa Cruz Neighbors Association

SCPD Police Dept.

UCSC Police Dept.

UCSC Good Neighbor Initiative

UCSC Community Rentals Office