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Campus (required) —Please choose an option—College of Southern NevadaDesert Research InstituteGreat Basin CollegeNevada State UniversityTruckee Meadows Community CollegeWestern Nevada College
Name of Injured/Damaged Party (required)
Street Address (required)
City (required)
State (required) AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
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Date of Incident (required)
Time of Incident (required)
Street Address Where Incident Occurred (required)
Please provide a detailed description of what happened.
Please include photos, witness statements, police reports, and any other supporting documents you may have.
(Please note: Documents must not exceed 5MB in size)
Contact Person (required)
Department
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