{"id":1537,"date":"2023-09-06T23:50:28","date_gmt":"2023-09-06T23:50:28","guid":{"rendered":"https:\/\/ct-prod-wp.taftcollege.edu\/forms\/?page_id=1537"},"modified":"2023-09-06T23:50:38","modified_gmt":"2023-09-06T23:50:38","slug":"csa-reporting-form","status":"publish","type":"page","link":"https:\/\/ct-prod-wp.taftcollege.edu\/forms\/campus-safety-forms\/csa-reporting-form\/","title":{"rendered":"CSA Reporting Form"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column]<div id=\"ultimate-heading-366669d0c5c0bee11\" class=\"uvc-heading ult-adjust-bottom-margin ultimate-heading-366669d0c5c0bee11 uvc-9604 \" data-hspacer=\"no_spacer\"  data-halign=\"left\" style=\"text-align:left\"><div class=\"uvc-heading-spacer no_spacer\" style=\"top\"><\/div><div class=\"uvc-main-heading ult-responsive\"  data-ultimate-target='.uvc-heading.ultimate-heading-366669d0c5c0bee11 h1'  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}' ><h1 style=\"font-weight:normal;\">CSA Reporting Form<\/h1><\/div><div class=\"uvc-sub-heading ult-responsive\"  data-ultimate-target='.uvc-heading.ultimate-heading-366669d0c5c0bee11 .uvc-sub-heading '  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}'  style=\"font-weight:normal;\">Campus Security Authorities (CSAs) can use this form to report incidents. <em><strong>This form is not for general student use, it is intended for trained Campus Security Authorities<\/strong><\/em>.<\/p>\n<p>For incidents requiring an immediate police response, contact the Taft Police Department at 661-763-3101 or by calling 911 if appropriate.<\/p>\n<p>Complete this form <strong>as soon as possible but no later than the next business day after the incident was reported to you<\/strong>.<\/div><\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar 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class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_60'  action='\/forms\/wp-json\/wp\/v2\/pages\/1537' data-formid='60' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LdUtCUoAAAAAK8BHm9bjuYo2AyRrM5wkTXmVBww' data-tabindex='0'><input id=\"input_6f787e6ddf316a4674909a60a958174d\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_6f787e6ddf316a4674909a60a958174d\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_60' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_60_4\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Header Information<\/h3><\/div><div id=\"field_60_1\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_60_1'>Date incident was reported to you<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_1' id='input_60_1' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_60_1_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_60_1_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_60_1' class='gform_hidden' value='https:\/\/ct-prod-wp.taftcollege.edu\/forms\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_60_2\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_60_2'>Date incident occurred<\/label><div class='gfield_description' id='gfield_description_60_2'>If multiple incidents were reported or if the date of occurrence is unknown, please note that in the Incident Information section below.<\/div><div class='ginput_container ginput_container_date'>\n                            <input name='input_2' id='input_60_2' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_60_2_date_format gfield_description_60_2\" aria-invalid=\"false\" \/>\n                            <span id='input_60_2_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_60_2' class='gform_hidden' value='https:\/\/ct-prod-wp.taftcollege.edu\/forms\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_60_3\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name of Campus Security Authority<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_60_3'>\n                            \n                            <span id='input_60_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_60_3_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_60_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_60_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_60_3_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_60_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_60_16\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_60_16'>Department<\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_60_16' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_60_17\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_60_17'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_17' id='input_60_17' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_60_18\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_60_18_container'>\n                                <span id='input_60_18_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_18' id='input_60_18' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_60_18' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_60_18_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_18_2' id='input_60_18_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_60_18_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_60_5\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Reporting Party (R\/P) or Victim Contact Information<\/h3><\/div><fieldset id=\"field_60_13\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Reported By:<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_60_13'>\n\t\t\t<div class='gchoice gchoice_60_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='The Victim'  id='choice_60_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_13_0' id='label_60_13_0' class='gform-field-label gform-field-label--type-inline'>The Victim<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='A Third Party'  id='choice_60_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_13_1' id='label_60_13_1' class='gform-field-label gform-field-label--type-inline'>A Third Party<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='gf_other_choice'  id='choice_60_13_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_13_2' id='label_60_13_2' class='gform-field-label gform-field-label--type-inline'>Other<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label><br \/><input id='input_60_13_other' class='gchoice_other_control' name='input_13_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_60_7\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >R\/P Name<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_60_7'>\n                            \n                            <span id='input_60_7_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_7.3' id='input_60_7_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_60_7_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_60_7_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_7.6' id='input_60_7_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_60_7_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_60_10\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_60_10'>R\/P A# (If applicable)<\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_60_10' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_60_8\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_60_8'>R\/P Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_60_8' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_60_9\" class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_60_9'>R\/P Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_9' id='input_60_9' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_60_28\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_60_28'>Relationship<\/label><div class='gfield_description' id='gfield_description_60_28'>If a third party (e.g. roommate, friend, parent) reported the crime to you, please enter the relationship of the third party to the victim:<\/div><div class='ginput_container ginput_container_text'><input name='input_28' id='input_60_28' type='text' value='' class='medium'  aria-describedby=\"gfield_description_60_28\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_60_11\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Agency Notified<\/h3><\/div><div id=\"field_60_12\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_60_12'>Agency (if any)<\/label><div class='gfield_description' id='gfield_description_60_12'>If, to your knowledge, a law enforcement agency was notified, please enter the name of that agency.<\/div><div class='ginput_container ginput_container_text'><input name='input_12' id='input_60_12' type='text' value='' class='medium'  aria-describedby=\"gfield_description_60_12\"    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_60_14\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Does the victim want the incident reported to law enforcement?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_60_14'>\n\t\t\t<div class='gchoice gchoice_60_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Yes'  id='choice_60_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_14_0' id='label_60_14_0' class='gform-field-label gform-field-label--type-inline'>Yes<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='No'  id='choice_60_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_14_1' id='label_60_14_1' class='gform-field-label gform-field-label--type-inline'>No<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_60_15\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Incident Information<\/h3><\/div><div id=\"field_60_19\" class=\"gfield gfield--type-textarea cucomment field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_60_19'>Location of incident<\/label><div class='gfield_description' id='gfield_description_60_19'>Building name, street address, office number, room number, etc. (see location details below).<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_19' id='input_60_19' class='textarea medium'  aria-describedby=\"gfield_description_60_19\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_60_20\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_60_20'>Time of incident (if known)<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_60_20' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_60_21\" class=\"gfield gfield--type-textarea cucomment field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_60_21'>Incident description<\/label><div class='gfield_description' id='gfield_description_60_21'>Please provide specific, detailed information. <\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_21' id='input_60_21' class='textarea medium'  aria-describedby=\"gfield_description_60_21\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_60_26\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Incident Classification<\/h3><\/div><fieldset id=\"field_60_22\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Incident Category<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_60_22'>\n\t\t\t<div class='gchoice gchoice_60_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Homicide'  id='choice_60_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_0' id='label_60_22_0' class='gform-field-label gform-field-label--type-inline'>Homicide<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Burglary'  id='choice_60_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_1' id='label_60_22_1' class='gform-field-label gform-field-label--type-inline'>Burglary<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Sex Offense'  id='choice_60_22_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_2' id='label_60_22_2' class='gform-field-label gform-field-label--type-inline'>Sex Offense<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Robbery'  id='choice_60_22_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_3' id='label_60_22_3' class='gform-field-label gform-field-label--type-inline'>Robbery<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Aggravated Assault'  id='choice_60_22_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_4' id='label_60_22_4' class='gform-field-label gform-field-label--type-inline'>Aggravated Assault<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Arson'  id='choice_60_22_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_5' id='label_60_22_5' class='gform-field-label gform-field-label--type-inline'>Arson<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Motor Vehicle Theft'  id='choice_60_22_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_6' id='label_60_22_6' class='gform-field-label gform-field-label--type-inline'>Motor Vehicle Theft<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Dating Violence'  id='choice_60_22_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_7' id='label_60_22_7' class='gform-field-label gform-field-label--type-inline'>Dating Violence<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Domestic Violence'  id='choice_60_22_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_8' id='label_60_22_8' class='gform-field-label gform-field-label--type-inline'>Domestic Violence<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Stalking'  id='choice_60_22_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_9' id='label_60_22_9' class='gform-field-label gform-field-label--type-inline'>Stalking<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Hate Crime (see below for additional information)'  id='choice_60_22_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_10' id='label_60_22_10' class='gform-field-label gform-field-label--type-inline'>Hate Crime (see below for additional information)<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Arrest for Liquor Law Violation'  id='choice_60_22_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_11' id='label_60_22_11' class='gform-field-label gform-field-label--type-inline'>Arrest for Liquor Law Violation<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Referral for Liquor Law Violation'  id='choice_60_22_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_12' id='label_60_22_12' class='gform-field-label gform-field-label--type-inline'>Referral for Liquor Law Violation<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_13'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Arrest for Drug Law Violation'  id='choice_60_22_13' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_13' id='label_60_22_13' class='gform-field-label gform-field-label--type-inline'>Arrest for Drug Law Violation<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_14'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Referral for Drug Law Violation'  id='choice_60_22_14' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_14' id='label_60_22_14' class='gform-field-label gform-field-label--type-inline'>Referral for Drug Law Violation<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_15'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Arrest for Weapons Violation'  id='choice_60_22_15' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_15' id='label_60_22_15' class='gform-field-label gform-field-label--type-inline'>Arrest for Weapons Violation<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_16'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Referral for Weapons Law Violation'  id='choice_60_22_16' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_16' id='label_60_22_16' class='gform-field-label gform-field-label--type-inline'>Referral for Weapons Law Violation<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_17'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='I am not sure how to classify this incident'  id='choice_60_22_17' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_17' id='label_60_22_17' class='gform-field-label gform-field-label--type-inline'>I am not sure how to classify this incident<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_22_18'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='gf_other_choice'  id='choice_60_22_18' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_22_18' id='label_60_22_18' class='gform-field-label gform-field-label--type-inline'>Other<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label><br \/><input id='input_60_22_other' class='gchoice_other_control' name='input_22_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_60_23\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is there any evidence this crime was motivated by bias?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_60_23'>\n\t\t\t<div class='gchoice gchoice_60_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Yes'  id='choice_60_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_23_0' id='label_60_23_0' class='gform-field-label gform-field-label--type-inline'>Yes<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_60_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='No'  id='choice_60_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_60_23_1' id='label_60_23_1' class='gform-field-label gform-field-label--type-inline'>No<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_60_24\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >If yes, please choose any\/all categories of bias that apply<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_60_24'><div class='gchoice gchoice_60_24_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.1' type='checkbox'  value='Race'  id='choice_60_24_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_60_24_1' id='label_60_24_1' class='gform-field-label gform-field-label--type-inline'>Race<span class=\"checkbox\" role=\"none\">\n\t\t\t<!--<svg class=\"brei-icon brei-icon-check\" focusable=\"false\">\n\t\t\t\t<use xlink:href=\"#brei-icon-check\"><\/use>\n\t\t\t<\/svg>-->\n\t\t<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_60_24_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.2' type='checkbox'  value='Gender'  id='choice_60_24_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_60_24_2' id='label_60_24_2' class='gform-field-label gform-field-label--type-inline'>Gender<span class=\"checkbox\" role=\"none\">\n\t\t\t<!--<svg class=\"brei-icon brei-icon-check\" focusable=\"false\">\n\t\t\t\t<use xlink:href=\"#brei-icon-check\"><\/use>\n\t\t\t<\/svg>-->\n\t\t<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_60_24_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.3' type='checkbox'  value='Ethnicity'  id='choice_60_24_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_60_24_3' id='label_60_24_3' class='gform-field-label gform-field-label--type-inline'>Ethnicity<span class=\"checkbox\" role=\"none\">\n\t\t\t<!--<svg class=\"brei-icon brei-icon-check\" focusable=\"false\">\n\t\t\t\t<use xlink:href=\"#brei-icon-check\"><\/use>\n\t\t\t<\/svg>-->\n\t\t<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_60_24_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.4' type='checkbox'  value='Religion'  id='choice_60_24_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_60_24_4' id='label_60_24_4' class='gform-field-label gform-field-label--type-inline'>Religion<span class=\"checkbox\" role=\"none\">\n\t\t\t<!--<svg class=\"brei-icon brei-icon-check\" focusable=\"false\">\n\t\t\t\t<use xlink:href=\"#brei-icon-check\"><\/use>\n\t\t\t<\/svg>-->\n\t\t<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_60_24_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.5' type='checkbox'  value='Disability'  id='choice_60_24_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_60_24_5' id='label_60_24_5' class='gform-field-label gform-field-label--type-inline'>Disability<span class=\"checkbox\" role=\"none\">\n\t\t\t<!--<svg class=\"brei-icon brei-icon-check\" focusable=\"false\">\n\t\t\t\t<use xlink:href=\"#brei-icon-check\"><\/use>\n\t\t\t<\/svg>-->\n\t\t<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_60_24_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.6' type='checkbox'  value='National Origin'  id='choice_60_24_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_60_24_6' id='label_60_24_6' class='gform-field-label gform-field-label--type-inline'>National Origin<span class=\"checkbox\" role=\"none\">\n\t\t\t<!--<svg class=\"brei-icon brei-icon-check\" focusable=\"false\">\n\t\t\t\t<use xlink:href=\"#brei-icon-check\"><\/use>\n\t\t\t<\/svg>-->\n\t\t<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_60_24_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.7' type='checkbox'  value='Gender Identity'  id='choice_60_24_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_60_24_7' id='label_60_24_7' class='gform-field-label gform-field-label--type-inline'>Gender Identity<span class=\"checkbox\" role=\"none\">\n\t\t\t<!--<svg class=\"brei-icon brei-icon-check\" focusable=\"false\">\n\t\t\t\t<use xlink:href=\"#brei-icon-check\"><\/use>\n\t\t\t<\/svg>-->\n\t\t<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_60_24_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.8' type='checkbox'  value='Sexual Orientation'  id='choice_60_24_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_60_24_8' id='label_60_24_8' class='gform-field-label gform-field-label--type-inline'>Sexual Orientation<span class=\"checkbox\" role=\"none\">\n\t\t\t<!--<svg class=\"brei-icon brei-icon-check\" focusable=\"false\">\n\t\t\t\t<use xlink:href=\"#brei-icon-check\"><\/use>\n\t\t\t<\/svg>-->\n\t\t<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_60_25\" class=\"gfield gfield--type-textarea cucomment field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_60_25'>Explain<\/label><div class='gfield_description' id='gfield_description_60_25'>If you answered \"yes\" to the Motivated by Bias question, please provide a brief summary of the evidence 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