Campus Security Authority Reporting Form


This form is for the reporting of any criminal offense to the Clery Act Compliance Coordinator for inclusion in the Annual Security Report. It assists with the compilation of statistical data for offenses/incidents that occur on SMC-affiliated property.

This is not a Police Report. If you would like to make a report to SMC Police for investigation of a crime, please call Campus Police at 310-434-4300.

For emergencies and crimes in progress, call 9-1-1.

Timely reporting: You are required by California law to immediately, or as soon as feasibly possible, report homicide, rape, robbery, aggravated assault, any type of sexual assault, and any type of hate crime.

Victim confidentiality: No information should be included on this form that would personally identify the impacted party without his/her/their consent.

I acknowledge that this report is not an emergency or crime in progress:
Reporting Party Information
Does the victim want the incident investigated by Police?*
Is this time an estimate?
Location Information
Did the crime occur in a property owned, controlled, or leased by SMC?*
If the crime occurred at an SMC-sponsored event, please name the specific event
If the crime occured on an SMC-sponsored or Student Org-sponsored trip, please provide information about the trip and lcoation of crime
Please provide exact address if you know it. If not, please describe where this incident occured with as much detail as possible
Please provide as much information as possible about the incident
Additional Report Information
What is the relationship between the victim(s) and the offender(s)?
If known, what type of force was used (including None)?
Has this offence been reported to anyone else at SMC?
If the victim consents to being identified, enter name and other identifying information here, including age, gender, and any other relevant information. If multiple impacted parties, please list them separately.
Do you have information about the offender(s)?