Bias Incident Reporting Form

Background Information

We value your safety and will protect your privacy. We will only contact you if we need more information in order to properly investigate the incident. Your contact information is not required to submit a report.

Enable additional features by logging in.

Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Learn more

on-campus or local address

Nature of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Name or Organization

Select Role

Phone number (if known)

Email address (if known)

Hall/Address (if known - or as much of address as you know)

Questions

Please provide a description of the incident or issue. Remember to include as much information as possible, including who was involved (if known) and who witnessed the situation. Dates, times, quotes, actions, behaviors, physical descriptions of individuals are all important.(Required) This field is required.

Would you like someone from the Administration to contact you about this incident? If so, please make sure you've included your contact information above.(Required)

Yes No

This field is required.

What is your affiliation with the University?

Undergraduate Student Graduate Student Staff Member Faculty Member Contracted Party Guest/Visitor

This field is required.

Is there any additional information to share?(Required) This field is required.

Supporting Documentation

It is critically important that evidence is preserved immediately. If graffiti or any other form of vandalism has occurred, please take photos before it is disrupted. Also take photos of any property damage, injuries, license plates of involved vehicles, etc. Do not erase or clean up graffiti or property damage, as law enforcement or other officials may need to see it. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission