Campus Security Authority Crime Report Form

A.T. Still University (ATSU) is required to comply with the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (Clery Act). Under the Clery Act, ATSU must designate Campus Security Authorities (CSAs) to receive reports of alleged crimes from students, employees, or other individuals.

What to do if you receive a report of a crime/incident:

  1. If someone is hurt or there is ongoing risk of danger to anyone, immediately dial 911 or ATSU Security. If 911 is called, also alert ATSU Security.
    • Kirksville Security: 660.349.9513
    • Mesa Security: 480.341.9075
  2. Report the incident without delay. This enables ATSU to take actions as required by law and for the safety of the campus community.

How to report:

  • If the incident is sexual in nature (sex or gender-based discrimination or harassment, or sexual misconduct including but not limited to dating violence, domestic violence, sexual assault, or stalking), EITHER:
    1. Complete this Crime Report Form and omit the identities of the persons involved. The Title IX coordinator will reach back to you for the identities; OR
    2. Email the Title IX coordinator at Include the identities of the persons involved in the email.
  • If the incident is not sexual in nature, EITHER:
    1. Complete this Crime Report Form; OR
    2. Call ATSU Security at the numbers above and provide the information verbally.

Please describe events clearly using information provided by the reporter. CSA crime reports become part of an investigative record which are subject to review by ATSU officials or potential disclosure in legal proceedings.

    Is it believed this incident was motivated by bias? *

    If "yes", identify the potential category of bias. Check all that apply.