Illinois State Police
Person Determined to Pose a Clear and Present Danger
It is the duty of law enforcement officials and school administrator to report to the Department of State Police when a
student or other person is determined to pose a clear and present danger to themselves, or to others, within 24 hours
of the determination. 20 Il. Admin. Code 1230.120.
This form must be completed in its entirety by the law enforcement official, principal, chief administrative officer, or
their designee making the determination. Clear and present danger reporting shall be used by the Department of
State Police to identify persons who, if granted access to a firearm or firearm ammunition, pose an actual, imminent
threat of substantial bodily harm to themselves or another person(s) that is articulable and significant or who will
likely act in a manner dangerous to public interest.
Completed forms and attachments should be faxed to the Illinois State Police, Firearm Services Bureau at 217/782-9139.
For questions or to confirm receipt of a fax, please call the Firearms Services Bureau, Monday through Friday, 8:30 a.m.
to 5:00 p.m. at 217/782-3700. For assistance from the Firearms Services Bureau beyond normal business hours, contact
the Statewide Terrorism and Intelligence Center at 877/455-7842. If immediate police assistance is required, contact
your local law enforcement agency or call 911.
REPORTING OFFICIAL
Name of Reporting Official:
Title of Reporting Official:
Name of Law Enforcement Agency / School:
Address:
Contact Information:
________________________________
________________________________
Phone
Fax:
_________________________________________________________________________
Email
Signature of Reporting Official:
Date:
INDIVIDUAL POSING A CLEAR AND PRESENT DANGER
Individual’s Name:
Date of Birth:
Individual’s Home Address:
Individual’s Campus Address (if applicable):
_____________________________________________
___________________________________________
_____________________________________________
___________________________________________
Individual’s Parents or Guardians Names (if applicable):
Individual’s Contact Phone Number(s):
ISP 2-649 (1/14)