Clery Travel Report Form

Main Content

Please submit this form after your travel to ensure you have complete information, including specific rooms/suites occupied.

If you have questions, please contact the Wake Forest University Clery Office at .

Group Name(Required)

Name of person submitting this form(Required)

First Last

Email(Required)

Travel Contact Information

I understand that I am a Campus Security Authority (CSA) for this trip and must report to the Wake Forest Police Department in a timely manner any crimes brought to my attention. To submit a crime please fill out the Clery Travel Reporting Form

Name (CSA in charge of group)(Required)

First Last

Title(Required)

Department(Required)

Phone(Required)

Email(Required)

Travel Timeframe

Departure Date(Required)

Return Date(Required)

Lodging/Facility Information

If group is staying at more than one lodging facility, please complete a separate form for EACH facility. Additionally, along with lodging, if during the trip the University “controls” any additional spaces (classrooms, meeting rooms, team meal spaces, etc.) please include in the section below marked with #.

Are you traveling for more than one day?(Required)

Yes

Check-in-Date(Required)

Check-out-Date(Required)

Name of facility(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

# Specific floor(s), room number(s), or unit number(s) occupied(Required)

The trip is(Required)

A one-time trip

Repeated each semester

Repeated annually

Other

Our group(Required)

Always stay at the exact same lodging facility

Uses various lodging facilities with each trip

Law Enforcement Agency Information

The University is required to collect and report crime statistics from local law enforcement agencies regarding certain non-campus lodging facilities or other controlled spaces where Wake Forest University students are housed or spaces they use during University sponsored overnight student travel. It is critical this information is provided by the CSA’s who are traveling with students overseas.

Name of the law enforcement agency having jurisdiction over lodging facility or other controlled space(s)(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add Another Facility?

Yes

2nd Facility

Are you traveling for more than one day?(Required)

Yes

Check-in-Date(Required)

Check-out-Date(Required)

Name of facility(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

# Specific floor(s), room number(s), or unit number(s) occupied(Required)

The trip is(Required)

A one-time trip

Repeated each semester

Repeated annually

Other

Our group(Required)

Always stay at the exact same lodging facility

Uses various lodging facilities with each trip

Law Enforcement Agency Information

Name of the law enforcement agency having jurisdiction over lodging facility or other controlled space(s)(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add Another Facility?

Yes

3rd Facility

Are you traveling for more than one day?(Required)

Yes

Check-in-Date(Required)

Check-out-Date(Required)

Name of facility(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

# Specific floor(s), room number(s), or unit number(s) occupied(Required)

The trip is(Required)

A one-time trip

Repeated each semester

Repeated annually

Other

Our group(Required)

Always stay at the exact same lodging facility

Uses various lodging facilities with each trip

Law Enforcement Agency Information

Name of the law enforcement agency having jurisdiction over lodging facility or other controlled space(s)(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add Another Facility?

Yes

4th Facility

Are you traveling for more than one day?(Required)

Yes

Check-in-Date(Required)

Check-out-Date(Required)

Name of facility(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

# Specific floor(s), room number(s), or unit number(s) occupied(Required)

The trip is(Required)

A one-time trip

Repeated each semester

Repeated annually

Other

Our group(Required)

Always stay at the exact same lodging facility

Uses various lodging facilities with each trip

Law Enforcement Agency Information

Name of the law enforcement agency having jurisdiction over lodging facility or other controlled space(s)(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add Another Facility?

Yes

5th Facility

Are you traveling for more than one day?(Required)

Yes

Check-in-Date(Required)

Check-out-Date(Required)

Name of facility(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

# Specific floor(s), room number(s), or unit number(s) occupied(Required)

The trip is(Required)

A one-time trip

Repeated each semester

Repeated annually

Other

Our group(Required)

Always stay at the exact same lodging facility

Uses various lodging facilities with each trip

Law Enforcement Agency Information

Name of the law enforcement agency having jurisdiction over lodging facility or other controlled space(s)(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

University Police

Popular Destinations

Popular Destinations

Travel Contact Information

Travel Timeframe

Lodging/Facility Information

Law Enforcement Agency Information

2nd Facility

Law Enforcement Agency Information

3rd Facility

Law Enforcement Agency Information

4th Facility

Law Enforcement Agency Information

5th Facility

Law Enforcement Agency Information