UIC Anonymous or Voluntary Incident Reporting Form

UIC Anonymous (or Voluntary) Incident Reporting Form

Introduction

UIC provides members of the UIC community with an electronic reporting option to encourage the community to share reports of alleged crimes with university officials. You may choose to incude your name and contact information in the report to allow for follow-up or investigation, or you may choose to report anonymously.

How is the information submitted through this form used?

Submissions of this reporting form are reviewed by the UIC Police Department Crime Statistics Unit. Submissions indicating sexual misconduct are also reviewed by a UIC Title IX Coordinator. The information provided through this form enables UIC to:

connect reporting persons (or others involved) to resources, when feasible and appropriate;
maintain an accurate record of the number, type, and location of incidents affecting a UIC campus or community;
maintain an accurate Daily Crime Log and publish accurate crime statistics in the UIC Annual Security and Fire Safety Report, in accordance with the Clery Act;
determine whether there is a pattern of crime with regard to a particular location, method, or assailant;
determine whether there is an ongoing threat to the campus community that would warrant a timely warning notice (i.e., determine whether an [URGENT] Public Safety Advisory email should be issued);
alert the UIC community to campus emergencies (i.e., issue UIC Alert emergency notifications);

Completion of this electronic form does not replace the filing of a formal complaint (with the UICPD, or your local law enforcement agency). To file a formal complaint, law enforcement must be contacted directly.

EMERGENCIES: If this is a serious crime or incident that may cause an imminent or ongoing threat to the campus community, contact the University of Illinois at Chicago (UIC) Police Department (PD) at (312) 355-5555 or 5-5555 from a campus phone or your local law enforcement agency by dialing 911.

Would you like to provide your contact information for investigation/follow-up purposes?

Yes
No, I would like to report anonymously

NOTICE: ANONYMOUS REPORT
By choosing to report anonymously, your identity will be unknown to anyone, including campus officials and other law enforcement officials. Options for investigation and/or disciplinary action are limited for anonymous reports, however, they help to provide campus with important data to classify and publish crime statistics and issue timely warnings to alert the UIC community of potential dangers.

Please enter only your first and last initials, this will help campus to avoid double-reporting:
For example: Enter "John Smith" as "JS"

Reporting party contact information:

Contact information is requested so the appropriate officials may follow-up with the reporting party to obtain further details regarding the incident, if necessary.
All reports are submitted to the UIC Police. Reports of Sexual Misconduct are also submitted to the UIC Title IX Coordinator.

First Name:

Last Name:

Phone Number, Including Area Code:

E-mail Address:

What is your involvement in the incident?

Victim

Witness

Offender

Other Third Party

Third Party Reporter: Describe your involvement in the incident you are reporting:

Examples: I am a friend of the victim or offender, I heard about the incident in a student org. meeting, someone posted about the incident online, etc.

Date Incident occurred:
Select the date the incident occurred.

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Time incident occurred:

Enter the approximate time or range of time that the incident occurred.

On which UIC Campus did the incident occur?
Select the campus on which the incident occurred from the drop-down menu.

Select the choice that best describes the location the incident occurred.
Click the Clery Geography to view campus maps to help identify the incident location.

On-campus Property
Any building or property owned or controlled by UIC or owned by UIC but controlled by another person, is frequently used by students, and supports institutional purposes. Examples: Behavioral Sciences Building, Student Centers East and West, School of Public Health & Psychiatric Institute, UIC Forum, Halsted St. Parking Structure, Thomas Beckham Hall, Curtis Granderson Stadium, Rockford College of Medicine East Building, College of Medicine at Peoria.
On-campus Student Housing Facility
Any student housing facility that is owned or controlled by UIC, or is located on property that is owned or controlled by UIC, and is within the reasonably contiguous geographic area that makes up the campus. I.e. Campus Housing.
Examples: Academic and Residential Complex (ARC), Student Residence and Commons Courtyard (CTY), James Stuckel Tower (JST), Marie Robinson Hall (MRH).
Noncampus Building or Property
Any building or property owned or controlled by a student organization that is officially recognized by UIC; or owned or controlled by UIC that is used in direct support of or in relation to the educational purposes, is frequently used by students, and is not within the same reasonably contiguous geographic area of the institution. Examples: Mile Square Health Center-South Shore.
Public Property
All public property, including thoroughfares, streets, sidewalks, and parking facilities, that is within the campus, or immediately adjacent to and accessible from the campus.
Off-campus Property
Any building or property not owned or controlled by UIC nor its registered student organizations, not including public property. Off-campus property may include private residences such as student apartments, and private businesses, such as restaurants and bars. Examples: Taylor Street Lofts, Presidential Towers, Peak Fitness, etc.

Please describe where the incident occurred, including addresses and room numbers, when possible.
Include building name, address, street name with cross streets or close address, or nearby buildings if the incident occurred outside.

Crime Classification

Are you reporting an incident of sexual misconduct, another type of criminal offense, or both?

Examples of sexual misconduct : Sexual assault, fondling, incest. domestic violence, dating violence, stalking, etc.
Examples of potential criminal offenses: Aggravated assault, arson, burglary, robbery, etc.

Sexual Misconduct, Dating/Domestic Violence, Stalking

Other Criminal Offense

Both

Attention: UIC Sexual Misconduct Policy and Options

Regardless of whether a victim elects to pursue a criminal complaint or whether the offense is alleged to have occurred on or off campus, UIC will assist victims of sexual misconduct and will provide each victim with written notice of their rights and options. Click the following links to access: Reporting Rights and Options or Survivor Support Resources (including how to get safe and get help, how to preserve evidence, and where to access on- and off-campus survivor advocacy and support).

For more information about UIC's Sexual Misconduct processes, see UIC's Sexual Misconduct Policy and/or contact UIC's Title IX Coordinator at (312) 996-8670 or titleix@uic.edu.

To be connected to UIC's confidential, trauma-informed victim advocacy services, contact the Campus Advocacy Network (CAN). Victims have the right to have an advocate accompany them throughout any processes in which they choose to engage. Click to e-mail a confidential advisor/advocate to discuss your needs and assess your on and off campus options, or call 312-413-8206.

I have been notified of UIC's Sexual Misconduct Policy Rights & Options.

Category of sexual misconduct:

Select any/all categories that describe the nature of the incident being reported.

Rape
The penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.
Fondling
The touching of the private body parts of another person for the purpose of sexual gratification, without the consent of the victim, including instances where the victim is incapable of giving consent because of his/her age or because of his/her temporary or permanent mental incapacity.
Incest
Sexual intercourse between persons who are related to each other within the degrees wherein marriage is prohibited by law.
Statutory Rape
Sexual intercourse with a person who is under the statutory age of consent. Illinois statutory rape law is violated when a person has consensual sexual intercourse with an individual under age 17. However, if the offender is in a position of authority or trust over the victim, the age of consent is raised to age 18. Persons age 16 or younger may not legally consent in Illinois. (If force was used or threatened or the victim was incapable of giving consent because of age or temporary or permanent mental impairment, classify as rape, not statutory rape.)
Dating Violence
Violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim.
(1) The existence of such a relationship shall be determined based on the reporting party's statement and with consideration of the length of the relationship, the type of relationship, and the frequency of interaction between the persons involved in the relationship.
(2) For the purpose of this definition - (i) Dating violence includes, but is not limited to, sexual or physical abuse or the threat of such abuse; or (ii) Dating violence does not include acts covered under the definition of domestic violence.
Domestic Violence
A felony or misdemeanor crime of violence committed - (i) By a current or former spouse or intimate partner of the victim; (ii) By a person with whom the victim shares a child in common; (iii) By a person who is cohabiting with or has cohabited with the victim as a spouse or intimate partner; (iv) By a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred; or (v) By any other person against an adult or youth victim who is protected from that person's acts under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred.
Stalking
(1) Engaging in a course of conduct directed at a specific person that would cause a reasonable person to - (i) Fear for the person's safety or the safety of others; or (ii) Suffer substantial emotional distress.
(2) For the purpose of this definition - (i) Course of conduct means two or more acts, including, but not limited to, acts in which the stalker directly, indirectly, or through third parties, by any action, method, device, or means follows, monitors, observes, surveils, threatens, or communicates to or about, a person, or interferes with a person's property; (ii) Reasonable person means a reasonable person under similar circumstances and with similar identities to the victim; or (iii) Substantial emotional distress means significant mental suffering or anguish that may, but does not necessarily, require medical or other professional treatment or counseling.

Hate Crime Classification

Do you believe the victim was intentionally targeted because of the perpetrator's bias against the victim's actual or perceived race, religion, sexual orientation, gender, gender identity, ethnicity, national origin, or disability?

Yes

No

Select any/all potential categories of prejudice believed to motivate the incident:

Race
A preformed negative attitude toward a group of persons who possess common physical characteristics, e.g., color of skin, eyes, and/or hair; facial features, etc., genetically transmitted by descent and heredity which distinguish them as a distinct division of humankind.
Religion
A preformed negative opinion or attitude toward a group of persons who share the same religious beliefs regarding the origin and purpose of the universe and the existence or nonexistence of a supreme being.
Gender
A preformed negative opinion or attitude toward a person or group based on their actual or perceived gender.
Gender Identity
A preformed negative opinion or attitude toward a person or group of persons based on their actual or perceived gender identity.
E.g. bias against transgender or gender non-conforming individuals. Gender non-conforming describes a person who does not conform to the gender-based expectations of society; a gender non-conforming person may not be a lesbian, gay, transgender, or bisexual but may be perceived as such.
Sexual Orientation
A preformed negative opinion or attitude toward a group of persons based on their actual or perceived sexual orientation. Sexual orientation is the term for a person's physical, romantic , and/or emotional attraction to members of the same and/or opposite sex.
Ethnicity
A preformed negative opinion or attitude toward a group of people whose membres identify with each other, through a common heritage, often consisting of a common language, common culture and/or ideology that stresses common ancestry. I.e. The concept of ethnicity differs from the closely related term "race" in that "race" refers to a grouping based mostly upon biological criteria, while "ethnicity" also encompasses additional cultural factors.
National Origin
A preformed negative opinion or attitude toward a group of people based on their actual or perceived country of birth.
I.e. This bias may be against people that have the name or accent associated with a national origin group, participate in certain customs associated with a national origin group, or because they are married to or associated with people of a certain national origin.
Disability
A preformed negative opinoin or attitude toward a group of persons based on their physical or mental impairments, whether such disability is temprary or permanent, congenital or acquired by heredity, accident, injury, advanced age or illness.

Provide a brief summary of the evidence supporting a bias motivation:

Incident Description

Briefly describe your account of the incident (what happened?):

Include any relevant information that would help UIC to classify the incident.

Persons Involved:

Number of Victims:

Number of Offenders:

Provide a brief description of the involved parties:
Include any relevant information about the individuals involved in the incident, including name(s), clothing, hair/eye/skin color(s), tattoos, vehicle information, etc.

Note: Anonymous reporters should not include any information that would jeopardize the anonymity of the anonymous reporter's identity.

Police Agencies Notified

To your knowledge, has a law enforcement agency been notified of this incident?
Examples: UIC Police, Chicago Police Department, Rockford Police Department, etc.

Yes

No

Would you like UIC Police to follow up with you?

If you select, "No" below, UICPD may still follow up with any of the parties named in this report.
Please note: Filing this form is NOT the same as filing a police report with the UIC Police (or anther police agency).

Yes

No

If a law enforcement agency has been notified, please enter the name of that agency:
Examples: UIC Police, Chicago Police Department, Rockford Police Department, etc.

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