*If your crime occurred on non-university property in Isla Vista, please contact the Santa Barbara Sheriff Office’s Isla Vista Foot Patrol at (805) 681-4179/4100 or www.sbsheriff.org/home/make-a-report/. You (The Person Filling Out This Form) Are - None -SurvivorWitnessStudent/Friend/RoommateStaff/Resident Staff MemberFacultyAdministrator Type of Problem Type of Problem - None -TheftBurglaryRoom Break InSex Offense/RapeDating/Domestic ViolenceStalkingViolence on CampusIllegal Drug UseAlcohol AbuseWeapons PossessionGraffiti/VandalismTraffic ComplaintLoitering/TransientsOther… If Other, please describe. Date/Time of Incident Date/Time of Incident: Date Date/Time of Incident: Time Location of Incident Details of Incident/Comments Victim Information Sex - None -FemaleMaleIntersex Gender Age UCSB Student? - None -YesNoUnknown Suspect Information Do you have a Suspect Description? - None -YesNo Name Sex - None -FemaleMaleIntersex Gender Approximate Age Address Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Height/Weight Eye Color Hair Color Length of Hair - None -ShortMediumLongBalding Facial Hair MoustacheBeardSideburnsNone Race or Ethnicity Wears Glasses? - None -YesNo Please describe any distinctive scars. Please describe any distinctive marks. Please describe any tattoos. Please describe any odors. Please describe the suspect's clothing. Please describe the suspect's speech or accent. Please describe any unusual phrases or actions (exact language) used to describe male/female genitalia, intercourse, etc. Evidence of drug or alcohol use? - None -YesNo Was the assailant ApologeticIgnoring your efforts to persuade them to stopAbusiveThreateningBlocking your exit or using their body to restrain youBrandishing a weapon Weapon Description Vehicle Description Additional Suspect Information Assault Information Was either party under the influence of alcohol or other drugs? - None -YesNoUnknown Did the victim receive medical treatment? - None -YesNoUnknown If Yes, please explain. Has the victim also reported the assault to the law enforcement authorities? - None -YesNoUnknown If Yes, which agency? If No, please explain why. Contact Information Name First Last Email Phone Number Address Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Submit