Clery Form

Education Abroad Program Location Form - Clery Act Compliance

2023 Calendar Year ONLY
One Form for Each Program Location

Program Name, Unit and Contact Information
IU Program Title:  

IU Unit: 

IU Campus: 

Name of individual submitting this information: 

Contact e-mail:

Location Details for Housing and Classroom/Meeting Space
Location Category (Housing or Classroom/Meeting Space): 

Location Title or Description: 

COMPLETE Street Address or Location: 

City: 

Country: 

SPECIFIC Dates of Use in 2023:

Contact Information for Local Police
Indiana University MUST e-mail or mail a letter to every local police department abroad; this information is critical.

 

Details of any Incidents of Crime (if known)
If you are aware of any incidents of crime at or near a program location, please provide brief description of incident(s), including reference to specific locations. (Please DO NOT include student names.)