Utah Tech University

Clery Travel Report Form

This form is to be completed for any College-related overnight travel, domestic and overseas, that includes students such as athletics, academics, clubs/organizations, etc. The federal Clery Act law requires that institutions track what is known as “non-campus” property, and report certain crimes that occur at those locations. Non-campus property includes property that Utah Tech controls on a short-term basis if there is a written agreement for the property, the property is frequented by students, and it is used to further Utah Tech’s educational mission. Utah Tech is required reach out to the local law enforcement agencies with jurisdiction over non-campus property and request crime statistics for the dates and times when Utah Tech controls the space. Utah Tech must provide the statistics, if any, to the federal government and publish them in the Annual Security and Fire Safety Report.

Please submit this form AFTER your travel to ensure you have complete information, including specific rooms/suites occupied. If you have questions, please contact Lindsey Bracken at clery@utahtech.edu.

Clery Travel Report - active

Travel Contact Information

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

Travel Timeframe

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 #.
Address
Address
City
State/Province/Region
Zip/Postal
Country
The trip is
Our group

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 Utah Tech 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.

Address
Address
City
State/Province/Region
Zip/Postal
Country
plus1 Add Lodging/Facility minus1 Remove

Contact

If you have any questions on whether your trip or program should be reported, please contact Clery Compliance Officer, Lindsey Bracken at clery@utahtech.edu

Lindsey Bracken

Clery Compliance Officer

Email: clery@utahtech.edu

Phone: 435-879-4331