There has been a power outage affecting the System Administration office in Las Vegas as of approximately 1:00pm. The Board of Regents Special Meeting and Investment Committee Meeting have been cancelled and will be reschedule for a future date.
Campus (required) —Please choose an option—College of Southern NevadaDesert Research InstituteGreat Basin CollegeNevada State UniversityTruckee Meadows Community CollegeWestern Nevada College
Contact Person's Name (required)
Email (required)
Phone
Driver's Name (required)
Agency/Department
Office Address (required)
City (required)
State (required) AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip Code (required)
Driver's License Number (required)
Issuing State (required) AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Expiration Date (required)
Vehicle ID Number (VIN) for NSHE vehicle (required)
EX Plate Number for NSHE vehicle (required)
Year for NSHE vehicle (required)
Make for NSHE vehicle (required)
Model for NSHE vehicle (required)
Describe damage to State Vehicle
Windshield damage only; no other party involved
Was another driver involved in this accident? (required) YesNo
Self-insurance card provided to driver/owner? (required) YesNo
Owner's Name (required)
Phone of other vehicle owner (required)
Owner's Street Address of other vehicle owner
City of other vehicle owner
State of other vehicle owner AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip Code of other vehicle owner
Owner's Insurance Company
Owner's Insurance Policy Number
Owner's Insurance Policy City
Owner's Insurance Policy State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Owner's Insurance Agent
Insurance Agent's Phone
Is the driver in the other vehicle different from the owner of the vehicle? (required)
YesNo
Driver's Name
Phone of other vehicle's driver
Driver's Street Address of other vehicle owner
City of other driver
State of other driver AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip Code of other vehicle driver
Other Driver's License Number
Issuing State for other driver's license AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Expiration Date for other driver's license
Describe damage to other vehicle and any injuries reported
Date of Accident (required)
Time of Accident (required)
Street Address where accident occurred of other vehicle owner
City where accident occurred
State where accident occurred AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip Code where accident occurred
Explain What Happened
Accident Reported to (NHP, Campus Police, or local law enforcement)
Report #
Citations Issued? YesNo
If "Yes," explain
Witnesses (Please include Name, Address, and Phone Number)
Witness card given/statement taken
Persons Injured (If injured person is a NSHE Employee, complete a Worker’s Compensation Claim Form.)
Please attach any supporting documents, including damage estimates and diagrams of the accident (Please note: Documents must not exceed 5MB in size)
