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Bias Incident Report Form


Who should use this form

This report form is for the use of current students, faculty, staff as well as University of North Carolina Asheville community members. Please provide detailed information regarding the bias incident you are referring. A bias incident is an act of discrimination, harassment, intimidation, violence or criminal offense committed against any person, group or property that appears to be intentional and motivated by prejudice or bias. Such are usually associated with negative feelings and beliefs with respect to others race, ethnicity, national origin, religion, gender, gender identity, sexual orientation, age social class, political affiliation, disability, veteran status, club affiliation or organizational membership.

Once the form is received, a member of the Bias Incident Response Team will review the information and take appropriate action, which may or may not include contacting the student, you, and any others you have identified. If you have any questions related to completing a Bias Incident Report Form, please call (828) 251-6577 or email lgivens@unca.edu.

DO NOT USE THIS FORM IN THE CASE OF AN EMERGENCY. IF THERE IS AN IMMEDIATE THREAT TO ANY PERSON OR PROPERTY CALL UNIVERSITY POLICE, (828) 251-6710 (on campus emergencies), OR 911 (off campus emergencies). This form is not monitored outside of regular business hours, Monday through Friday from 8:00am-5:00pm.

Background Information

 
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Involved Parties

If you know the names of any person involved in this incident and feel safe disclosing, please do so below. There is an option to add multiple individuals' information.

Involved party 1

Questions

Please provide us more information about the incident itself and the target(s) of the incident.

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Who was/were the target(s)? Check all that apply:(Required)
You must make at least one selection.
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What is the ethnicity or cultural background of the target(s)? Check all that apply:(Required)
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Gender identity targeted in this incident? if so, please check all that apply:(Required)
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Sexual orientation targeted in this incident? If so, please check all that apply:(Required)
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Disability targeted in this incident? If so, please check all that apply:(Required)
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Age targeted in this incident? If so, please check all that apply:(Required)
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Who was/were the alleged offender(s)? Check all that apply:(Required)
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Was any individual involved with this incidents under the influence of an intoxicant?
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Would you like a member of the Bias Incident Response Team to follow up with you?(Required)
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How would you like us to follow up with you?(Required)
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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.

Submission