Alexandria Campus Police

Police Office
NVCC Alexandria Campus
3001 North Beauregard St.
Alexandria, VA 22311-5097

Room: AA 240
Phone: (703) 845-6270
Fax: (703) 845-6045

Loss Report for Insurance Companies and Outside Agencies
Northern Virginia Community College, Alexandria Campus

Address Last Seen
3001 N. Beauregard St.
Alexandria, VA 22311

Last Seen

Date
Location

Personal Information

First Name
Last Name
E-mail Address
Address

City
Zip	State

Phone (H)
Phone (W)
Phone (C)

Lost Items
I am reporting the listed item(s) lost/misplaced and a report is needed for insurance purposes or for replacement purposes.

	Type	Description
1.
2.
3.
4.
5.

Release Agreement
By checking the box below, you agree that the information you have reported on this form is accurate. Note: This form will not be processed unless you are able to check the box below.

I certify that all of the information reported on this form is accurate. It shall be unlawful for any person to knowingly give a false report as to the commission of any crime to any law enforcement official with intent to mislead. A violation of the provision, 18.2-461, of this section shall be punishable as a Class 1 misdemeanor.

Northern Virginia Community College
3001 North Beauregard St.
Alexandria, Virginia 22311-5097

Tel: 703 845-6200
V/TDD: 703 845-6016