Bias Incident Reporting Form

Background Information

You may submit this form anonymously. If you choose to do so, our ability to respond may be limited. If you are comfortable being contacted, please provide your contact information in this section.

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Your full name (optional):

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Your phone number (optional):

Your email address (optional):

Email address must be of a valid format.

How do YOU Identify?(Required):

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Date of incident (or approx.)(Required):

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Time of incident (or approx.):

Location of Incident:

Your role(Required)

Experienced it (you were the target) Witnessed it (you were present, but not the target) Reported to me by another individual Heard about it after the fact

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Please provide as much detailed information as possible to better assist in our investigation and response to the incident.(Required) This field is required.

Please indicate your interest in being contacted by someone for a follow up. If you provide your name in this report and/or agree to a follow up discussion, the University will make every effort to maintain your anonymity in accordance with your wishes.(Required)

Please contact me - I would like to speak with someone (DON'T FORGET TO PROVIDE YOUR CONTACT INFORMATION ABOVE) Please do not contact me - I wanted to make a report but do not wish to speak with anyone further about this You can contact me if necessary but I otherwise don't need someone to follow up with me (DON'T FORGET TO PROVIDE YOUR CONTACT INFORMATION ABOVE)

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As the University considers your report and determines an appropriate response, your suggestions are welcome. Would you like the University to respond to this incident?(Required) This field is required.

If yes, please describe any suggested responses below. This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Background Information

Supporting Documentation

Submission