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.
4647 Stone Avenue, PO Box 5199
Sioux City, Iowa 51102-5199
firstname.lastname@example.org / email@example.com
Western Iowa Tech Community College does not discriminate on the basis of race, creed, color, gender, national origin, religion, age, disability, sexual orientation, gender identity, veteran status or any other protected basis as defined in Iowa or federal law as amended from time to time in its educational programs, activities, admission procedures or employment practices. Individuals who believe they have been discriminated against may file a complaint through the College's Grievance or Complaint Procedures. Complaint or Grievance Forms and Procedures may be obtained from the WITCC Human Resources Department, Dr. Robert H. Kiser Building, Room A242, (712) 274-6400, Ext. 1220.
View our Privacy Statement.