Silent Witness


Silent Witness Form

1. Type of Incident: Specify:

2. When did it occur?

Day

Mo/Date/Yr

Time

3. Where did it occur?
*If On campus, select location below:

Specific location:

Perpetrator Details

4. Perpetrator 
(if known)
?

Name:

Race Sex Complexion
     
Height Weight Age
5. Unknown Perpetrator Description:

Race Sex Complexion
     
Height Weight Age
6. Was anyone else involved?
Other witnesses
(please list full names)?
  *If Yes, please describe them below:

7. Briefly describe incident:

*Optional Contact Info

May we contact you? *If Yes, please fill out below. You may choose to give your phone # OR email OR BOTH.
Name (optional):
Phone # (optional):
E-mail (optional):

*DISCLAIMER: All information submitted is for the use of the Delgado Campus Police Department ONLY. And will not be given out or sold to any external/internal affiliates. Your contact information will strictly be used for the Campus Police Department to contact you and gain further information about the incident. You will not be held responsible for any reason when or if you report an incident to the Delgado Campus Police Department. The sole purpose of the silent witness form is to help everyone at Delgado stay safe.

*(Please make sure all information is accurate to your knowledge before submitting)