University of California, Santa Cruz

Campus Security Authority Annual Crime Report Notification

This form is to be used by identified "campus security authorities" who are required under the federal Clery Act to report information they receive about crimes. The information collected from these forms will be used to compile statistics to be included in the UCSC Annual Report. For more information about Campus Security Authority responsibilities and the crime reporting process, please see PowerPoint presentation at

The University of California urges all crime victims and witnesses to report criminal acts to the police, and to report University policy violations to the appropriate office (e.g., student conduct violations to the Office of Student Judicial Affairs at 831-459-4447). However, if a reporting person requests anonymity, this request must be honored to the extent permitted by law. Accordingly, no information should be included on this form that would personally identify the victim without his/her consent.

Campus Police will use the information submitted to determine the appropriate category for the crime in the Annual Security Report. Please forward completed forms to Teri Taylor at, or by fax to 831-458-5021.

Campus Security Authority name: 

Campus Security Authority Position: 

Phone number:     E-mail: 

I have no crimes to report for calendar year 2011
 (If you have no crimes to report, please click submit to return the form to
I received reports of crime(s) in calendar year 2011.  A separate Crime Report Form has been completed for each of these crimes.  To complete a Crime Report Form,  click here

Comments or Message for Sgt. Cabriales: