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Bias Incident Reporting Form


IF YOU OR SOMEONE ELSE IS IN IMMEDIATE DANGER, Please Call 911 or Campus Public Safety at (802) 865-6465


Please note that reports are reviewed during normal business hours and may not be immediately addressed.

Champlain College is committed to fostering a safe and welcoming campus community for all students and employees. If you have been witness to or the target of a bias or hate incident, please use this online form to make the College aware of this incident. .

The Bias Education & Response Team will make every effort to respect your privacy. Please be aware, however, that in certain circumstances, particularly when it involves safety or potential criminal action, we may not be able to guarantee complete anonymity. In such cases, the team will discuss options with the reporter and others involved as appropriate.

Background Information

 
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Involved Parties

Please list the individuals involved (EXCLUDING yourself), including as many of the listed fields as you can provide. If you have listed your information as the person submitting the report, you DO NOT need to include duplicate information. Note:"Respondent" refers to the individual about whom you have concerns.

Involved party 1

Questions

TYPE OF INCIDENT Below are categories that correspond to the types of bias incidents. Check all that apply.(Required)
You must make at least one selection.
TYPE OF BIAS (PERCEIVED OR CONFIRMED) Please check all the categories below that describe this incident. We also strongly encourage you to fully describe, in the narrative section below, all the details of the incident, including the reasons you believe the incident was motivated by bias.(Required)
You must make at least one selection.
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Have you reported this to Campus Public Safety?(Required)
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If this report involves you, how would you like us to follow up with you?
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If you are submitting this report on behalf of others, are they aware?(Required)
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Supporting Documentation

Please submit any supporting documentation here. This may include things like screen shots, photos, or videos. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission