NMSU - Campus Community Incident Report Form

Person Submitting Report

Your Full Name:

Position/title/student status:

Your Phone Number:

Your Email Address:

Email address must be of a valid format.

Nature of this Report(Required):

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Please select the appropriate type of concern being reported

Date of Incident(Required):

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Time of Incident:

Location of incident(Required):

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Specific Location of Incident:

The Name of the Individual(s) and/or Student Organization(s) who you would like to report

Persons Name

Status of Individual(s) Being Report

Aggie ID Number

DOB (YYYY-MM-DD)

Phone Number

Email Address

Description of Incident or Situation

Please describe the situation or incident with as much detail as possible and use specific, concise, objective language. Focus on the Who, What, When, Where, How, and Why of the incident. Indicate specific people, words, phrases, and interactions. Please try to use specific names instead of pronouns (he, she, they, etc.) when referring to people in the body of the report. When possible, we encourage the use of direct quotes, even in incidents when the language may be profane or abusive. For example, “Joe Aggie shook his fist at me and said ‘you are a stupid loser’” is more helpful than “Joe Aggie was threatening and used aggressive language with me.”

Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how).(Required) This field is required.

If appropriate, did you address your concern directly with the individual or anyone else? If yes, please provide details of that interaction.(Required) This field is required.

Did police respond?(Required)

Yes No

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Please provide the name of the police department (UPD, Las Cruces, other), report number(s), officer name(s) and additional information that may be helpful. This field is required.

Select any of the following that apply:

Hate or Bias incident Medical transport occurred Arrest was made

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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Person Submitting Report

The Name of the Individual(s) and/or Student Organization(s) who you would like to report

Description of Incident or Situation

Supporting Documentation

Submission