Immigration on Campus Reporting

Please use this form if you are approached by an Immigration Officer requesting information, documents, or access about someone other than yourself.

Cal State LA is committed to cultivating and maintaining a campus environment that is safe and welcoming for all members of our community, regardless of immigration status.

For more information, please visit https://www.calstatela.edu/immigration

Contact Information

First

Last

College/Department/Division/Area

Your group

Student

Faculty

Staff

Other…

Phone Number

Other Contact Information

Please provide any addition ways we can contact you not listed here.

Details of the Encounter

Where did the encounter occur?

Please clarify date, time, location of contact, etc.

What was the name of the Officer?

First and Last Name (enter N/A if not available)

What was the Officer Badge Number?

Badge number or other identification number. (enter N/A if not available)

What was the name of the Agency?

Agency Affiliation (enter N/A if not available)

Officer Contact Information

Please provide Officer's email and/or phone with area code. (enter N/A if not available)

What was the request?

Please describe the nature of the request.

What was the outcome?

Please describe the actions you took.

Additional Information

Additional Comments

Please provide any additional information.

File Upload

Please upload any supporting files.
One file only.
256 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

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