{"id":5216,"date":"2024-03-07T15:19:02","date_gmt":"2024-03-07T23:19:02","guid":{"rendered":"https:\/\/nshe.nevada.edu\/system-administration\/?page_id=5216"},"modified":"2024-05-06T15:50:31","modified_gmt":"2024-05-06T22:50:31","slug":"property-loss-form","status":"publish","type":"page","link":"https:\/\/nshe.nevada.edu\/system-administration\/departments\/risk-management\/property-loss-form\/","title":{"rendered":"NSHE Property Loss Report Form"},"content":{"rendered":"\n    <div id=\"\" class=\"card-standard content-box default-shadow   \">\n        <div class=\"content-box-header\">\n            <div class=\"columns\">\n                <div class=\"column\">\n                    <h2>NSHE Property Loss Report Form<\/h2>\n                <\/div>\n            <\/div>\n        <\/div>\n        <div class=\"institution-border\">\n            <svg class=\"border-block csn\"><rect  \/><\/svg>\n            <svg class=\"border-block dri\"><rect  \/><\/svg>\n            <svg class=\"border-block gbc\"><rect  \/><\/svg>\n            <svg class=\"border-block nsc\"><rect  \/><\/svg>\n            <svg class=\"border-block tmcc\"><rect  \/><\/svg>\n            <svg class=\"border-block unlv\"><rect  \/><\/svg>\n            <svg class=\"border-block unr\"><rect  \/><\/svg>\n            <svg class=\"border-block wnc\"><rect  \/><\/svg>\n        <\/div>\n        <div class=\"content-box-body\">\n            \n<div>\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f5220-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"5220\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/system-administration\/wp-json\/wp\/v2\/pages\/5216#wpcf7-f5220-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"海角乱伦社区 form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"5220\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f5220-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<h3>Incident Details\n<\/h3>\n<div class=\"columns\">\n\t<div class=\"column is-half\">\n\t\t<p><label><strong>Campus<\/strong> <span class=\"text-required\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"campus\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"campus\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"College of Southern Nevada\">College of Southern Nevada<\/option><option value=\"Desert Research Institute\">Desert Research Institute<\/option><option value=\"Great Basin College\">Great Basin College<\/option><option value=\"Nevada State University\">Nevada State University<\/option><option value=\"Truckee Meadows Community College\">Truckee Meadows Community College<\/option><option value=\"Western Nevada College\">Western Nevada College<\/option><\/select><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"columns\">\n\t<div class=\"column\">\n\t\t<p><label><strong>Date of Incident<\/strong> <span class=\"text-required\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"incident-date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"incident-date\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label><strong>Time of Incident<\/strong> <span class=\"text-required\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"incident-time\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"incident-time\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"columns\">\n\t<div class=\"column\">\n\t\t<p><label><strong>Street Address Where Loss Occurred<\/strong> <span class=\"text-required\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"street-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"street-address\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"columns\">\n\t<div class=\"column is-half\">\n\t\t<p><label><strong>City<\/strong> <span class=\"text-required\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label><strong>State<\/strong> <span class=\"text-required\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"state\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"state\"><option value=\"Alabama\">Alabama<\/option><option value=\"Alaska\">Alaska<\/option><option value=\"Arizona\">Arizona<\/option><option value=\"Arkansas\">Arkansas<\/option><option value=\"California\">California<\/option><option value=\"Colorado\">Colorado<\/option><option value=\"Connecticut\">Connecticut<\/option><option value=\"Delaware\">Delaware<\/option><option value=\"Washington DC\">Washington DC<\/option><option value=\"Florida\">Florida<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Hawaii\">Hawaii<\/option><option value=\"Idaho\">Idaho<\/option><option value=\"Illinois\">Illinois<\/option><option value=\"Indiana\">Indiana<\/option><option value=\"Iowa\">Iowa<\/option><option value=\"Kansas\">Kansas<\/option><option value=\"Kentucky\">Kentucky<\/option><option value=\"Louisiana\">Louisiana<\/option><option value=\"Maine\">Maine<\/option><option value=\"Maryland\">Maryland<\/option><option value=\"Massachusetts\">Massachusetts<\/option><option value=\"Michigan\">Michigan<\/option><option value=\"Minnesota\">Minnesota<\/option><option value=\"Mississippi\">Mississippi<\/option><option value=\"Missouri\">Missouri<\/option><option value=\"Montana\">Montana<\/option><option value=\"Nebraska\">Nebraska<\/option><option value=\"Nevada\" selected=\"selected\">Nevada<\/option><option value=\"New Hampshire\">New Hampshire<\/option><option value=\"New Jersey\">New Jersey<\/option><option value=\"New Mexico\">New Mexico<\/option><option value=\"New York\">New York<\/option><option value=\"North Carolina\">North Carolina<\/option><option value=\"North Dakota\">North Dakota<\/option><option value=\"Ohio\">Ohio<\/option><option value=\"Oklahoma\">Oklahoma<\/option><option value=\"Oregon\">Oregon<\/option><option value=\"Pennslyvania\">Pennslyvania<\/option><option value=\"Rhode Island\">Rhode Island<\/option><option value=\"South Carolina\">South Carolina<\/option><option value=\"South Dakota\">South Dakota<\/option><option value=\"Tennessee\">Tennessee<\/option><option value=\"Texas\">Texas<\/option><option value=\"Utah\">Utah<\/option><option value=\"Vermont\">Vermont<\/option><option value=\"Virginia\">Virginia<\/option><option value=\"Washington\">Washington<\/option><option value=\"West Virginia\">West Virginia<\/option><option value=\"Wisconsin\">Wisconsin<\/option><option value=\"Wyoming\">Wyoming<\/option><\/select><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label><strong>Zip Code<\/strong> <span class=\"text-required\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"zipcode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"zipcode\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"columns\">\n\t<div class=\"column\">\n\t\t<p><label><strong>Estimated Value of Loss (In $USD)<\/strong> <span class=\"text-required\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"estimated-loss\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"estimated-loss\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"columns\">\n\t<div class=\"column\">\n\t\t<p><label><strong>Provide a detailed description of what happened and what was damaged\/lost.<br \/>\n<\/strong> <span class=\"text-required\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"incident-details\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"incident-details\"><\/textarea><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"columns\">\n\t<div class=\"column\">\n\t\t<p><label>Please include photos, witness statements, police reports, and any other supporting documents you may have.<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"supporting-documents\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.doc,.docx,.xls,.xlsx,.jpg,.jpeg,.png,.gif,.ppt,.pptx,.avi,.ogg,.m4a,.mov,.mp3,.mp4,.mpg\" aria-invalid=\"false\" type=\"file\" name=\"supporting-documents\" \/><\/span><\/label>\n\t\t<\/p>\n\t\t<p><em>(Please note: Documents must not exceed 5MB in size)<\/em>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<h3>海角乱伦社区 Details\n<\/h3>\n<div class=\"columns\">\n\t<div class=\"column\">\n\t\t<p><label><strong>Name of 海角乱伦社区 Person<\/strong> <span class=\"text-required\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"contact-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact-name\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"columns\">\n\t<div class=\"column\">\n\t\t<p><label><strong>Email<\/strong> <span class=\"text-required\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"contact-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"contact-email\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"columns\">\n\t<div class=\"column\">\n\t\t<p><label><strong>Phone<\/strong> <span class=\"text-required\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"contact-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact-phone\" \/><\/span><\/label>\n\t\t<\/p>\n\t\t<div class=\"transparency-text\">\n\t\t\t<p>NSHE System Administration provides administrative support to all public higher education institutions in Nevada. Our SMS messaging frequency will operate on a daily basis from 1 to 100 for all company members.\n\t\t\t<\/p>\n\t\t\t<p>By checking this box and providing your mobile number, you are agreeing to receive SMS messages from NSHE System Administration. Reply HELP for customer care contact information. Message frequency may vary and message and data rates may apply. You may reply \"STOP\" to unsubscribe at any time.\n\t\t\t<\/p>\n\t\t\t<p>To learn more view our full <a href=\"https:\/\/nshe.nevada.edu\/privacy\/\" target=\"_blank\">privacy statement<\/a> and review our <a href=\"https:\/\/nshe.nevada.edu\/sms-terms-and-conditions\/\" target=\"_blank\">SMS Terms and Conditions<\/a>.\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div id=\"contact-optin\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"contact-sms-consent\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"contact-sms-consent[]\" value=\"I consent to receiving text messages From NSHE and understand that message data rates may apply.\" \/><span class=\"wpcf7-list-item-label\">I consent to receiving text messages From NSHE and understand that message data rates may apply.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"columns\">\n\t<div class=\"column\">\n\t\t<p><label><strong>Fax<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"contact-fax\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact-fax\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"columns\">\n\t<div class=\"column\">\n\t\t<p><label><strong>Department<\/strong> <span class=\"text-required\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"contact-department\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact-department\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column\">\n\t\t<p><label><strong>PG Number<\/strong> <span class=\"text-required\"><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"contact-pgnumber\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact-pgnumber\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n<\/div>\n        <\/div>\n    <\/div>\n\n    ","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":682,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"views\/template-2-widget-custom.blade.php","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"folder":[85],"class_list":["post-5216","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/nshe.nevada.edu\/system-administration\/wp-json\/wp\/v2\/pages\/5216","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nshe.nevada.edu\/system-administration\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/nshe.nevada.edu\/system-administration\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/nshe.nevada.edu\/system-administration\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/nshe.nevada.edu\/system-administration\/wp-json\/wp\/v2\/comments?post=5216"}],"version-history":[{"count":7,"href":"https:\/\/nshe.nevada.edu\/system-administration\/wp-json\/wp\/v2\/pages\/5216\/revisions"}],"predecessor-version":[{"id":5588,"href":"https:\/\/nshe.nevada.edu\/system-administration\/wp-json\/wp\/v2\/pages\/5216\/revisions\/5588"}],"up":[{"embeddable":true,"href":"https:\/\/nshe.nevada.edu\/system-administration\/wp-json\/wp\/v2\/pages\/682"}],"wp:attachment":[{"href":"https:\/\/nshe.nevada.edu\/system-administration\/wp-json\/wp\/v2\/media?parent=5216"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/nshe.nevada.edu\/system-administration\/wp-json\/wp\/v2\/categories?post=5216"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/nshe.nevada.edu\/system-administration\/wp-json\/wp\/v2\/tags?post=5216"},{"taxonomy":"folder","embeddable":true,"href":"https:\/\/nshe.nevada.edu\/system-administration\/wp-json\/wp\/v2\/folder?post=5216"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}