Campus Security Authority Reporting Form

To assist the Old Dominion University in complying with the federally mandated Clery Act, the Campus Security Authorities (CSA) form should be utilized by CSA to report crimes to the Clery Coordinator as soon as possible after a crime has been reported to the CSA. Under the Clery Act, a crime is reported to a CSA when a student, employee, or third party brings information about an alleged crime to the attention of the CSA and the CSA believes the report was made in good faith. The Clery Coordinator will use the information provided in this form to classify the crime for purposes of inclusion in the University's annual crime statistics. Please provide as much information as possible. If you have any questions, please contact the Old Dominion University Clery Coordinator at or 757-683-5665.