This form is to be completed by a College Campus Security Authority (CSA) who is required, under the federal Clery Act, to report information they receive about qualifying crimes. The information collected from these forms will be used to compile statistics to be included in Western Iowa Tech Community College's annual security report.

Do not provide name/contact information if the person reporting the incident requests confidentiality.

The CSA provides as much of the requested information on the form, excluding identity if confidentiality is requested, as s/he knows. The Security Department will use the submitted information to determine the appropriate classification of the incident.