Citizen Survey Form

LSU Police Department
204 South Stadium Road
Baton Rouge, LA 70803
Emergencies dial 911
Non-emergencies 225-578-3231

If you responded "Yes" to Question 2, please answer Questions 3-6; otherwise, please skip to Question 7.

By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

I authorize that all information provided on this form, including any and all personal, financial, and academic data may be shared with the LSU Police Department, necessary LSU personnel, and/or law enforcement entities to facilitate thorough investigation and response. This data will be securely retained if required by law or policy, for the scheduled amount of time designated by the LSUPD Records Retention Schedule approved by the Louisiana Secretary of State, Division of Archives. To learn more about privacy at LSU, please see the LSU Privacy Statement at

Provide your email address if you would like to receive a copy of your completed survey.