Campus Police Department Police Report Request Form printable pdf download

CAMPUS POLICE DEPARTMENT

POLICE REPORT REQUEST

Date: _________________________

I (Your Full Name) ______________________________________________________________ hereby request a copy of

Fitchburg State University Campus Police Department Report Number: ________________________________________

Incident Details (if known)

Date:______________Time: ______________ h AM h PM

Investigating Officer: ____________________________

Victim: _____________________________________________ Suspect: ______________________________________

Location: _________________________________________________________________________________________

Nature of Call/Report: _______________________________________________________________________________

Other Information: __________________________________________________________________________________

Requesting Individual's Information

Full Name (First, Middle Initial, Last): ___________________________________________________________________

Organization/ Affiliation Name: ________________________________________________________________________

Address:__________________________________________________________________________________________

City/State/Zip Code:_________________________________________________________________________________

FSU P.O. Box Number (if applicable): ___________________________________________________________________

Phone: Home: ( _________ ) ___________________________ Business: ( _________ ) _________________________

Cell: ( _________ ) ___________________________________

Location where you'd like correspondence/report sent if different from FSU P.O. Box #: ____________________________

Reason for Request

_________________________________________________________________________________________________

ANY information in this report or otherwise that is received from Fitchburg State University and/or the Fitchburg State

University Campus Police Department will be used for lawful purposes only. I understand that I may be subject to criminal

and/or civil action otherwise.

Applicant's Signature: _________________________________ Date:_____________Time: ___________ h AM h PM

Your request will be processed as soon as possible in our attempt to provide you with the best service. Please remember that

there may be numerous factors beyond our control which may occur causing a delay. Please allow 2 weeks for processing.

Notice to Operator and Owner Involved in Accident

If there is damage exceeding $1,000 OR personal injury results, you must file an accident report with the RMV and the

FSU Police Department within five (5) business days. Accident forms may be obtained from any Police Department, RMV,

or Insurance Company. We suggest that you report all accidents immediately and promptly notify your insurance company.

—For Official Use Only—

Request for copy of report: h Granted h Denied If Denied, Reason: ____________________________________

Report #: __________________________________________ Processed By: ________________________________

Print Services

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Campus Police Department Police Report Request Form