Clery : Trip Reporting Form

Trip Reporting Form

To comply with the Clery Act, universities are required to disclose statistics for specific crimes that occur during university-sponsored trips to non-campus locations that are frequently used by students and controlled by the university during a trip (e.g., a lease or rental agreement is in place to include hotel rooms), and used to support educational purposes.

The form should be filled out by a single point of contact for the university-sponsored trip. This is typically a staff or faculty member.

West Chester University is required to request from the local law enforcement agencies Clery Act crime statistics that occurred during a qualifying WCU-sponsored trip. Any statistics that are required by the Clery Act to be disclosed to the public will be reported in West Chester's Annual Security Report and Annual Fire Safety Report.

Please submit this form for Domestic (within the U.S.) University-sponsored trips that meet the following "submit form" requirements.

If the trip takes place internationally, please report the trip through International Programs and Services by contacting them at 610-436-3515 or at StudyAbroad@wcupa.edu.
For a Recognized Student Organization at the University Park campus, please report the trip through either the Office of Fraternity or Sorority Life or Student Leadership and Involvement.

SUBMIT THIS FORM IF YOUR TRIP IS:	DO NOT SUBMIT THIS FORM IF YOUR TRIP IS:
University-sponsored overnight trip at repeat lodging location	University-sponsored field trip at locations that the University does not own or control (no overnight stays or contractual agreements for control of space)
University-sponsored short-stay "away" trips of more than one night	One overnight, University-sponsored trip (not a repeat trip to repeat location)
University-sponsored field trip to locations owned or controlled by the University (no overnight stay required)	Non-University sponsored private trips by students regardless of length of trip

If you have any questions on whether your trip should be reported, please contact the Clery Compliance Officer at clery@wcupa.edu.

Contact Information

Please make sure you have filled in all required fields with valid information.

First Name:

Last Name:

Position/Title:

Email:

Phone:

- Phone (next 3 digits): - Phone (next 4 digits):

Sponsoring Department or University Organization:

Trip Information

Please make sure you have filled in all required fields with valid information.

Location Type (i.e. lodging/hotel, conference facility, or other contracted location):

Is there a written location agreement?

Yes No

Arrival Date (date students will be arriving at this location):

Departure Date (date students will be departing at this location):

Location Information

Please make sure you have filled in all required fields with valid information.

Name of Location:

Address:

City:

State:

Zip Code:

University Occupied Room Numbers (if applicable):

Local Police Jurisdiction/Local Law Enforcement Agency Contact Information

Please make sure you have filled in all required fields with valid information.

Department Name:

Address:

City:

State:

Zip Code:

Phone:

- Phone (next 3 digits): - Phone (next 4 digits):

Email (if known):

Were additional accommodation locations sued for this trip?

Yes No

Additional Location Information

Please make sure you have filled in all required fields with valid information.

Name of Location:

Address:

City:

State:

Zip Code:

University Occupied Room Numbers (if applicable):

Local Police Jurisdiction/Local Law Enforcement Agency Contact Information

Please make sure you have filled in all required fields with valid information.

Department Name:

Address:

City:

State:

Zip Code:

Phone:

- Phone (next 3 digits): - Phone (next 4 digits):

Email (if known):