University of Wisconsin - Stevens Point Bias Incident Report

Background Information

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Your full name:

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Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Date of incident(Required):

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Time of incident:

Location of incident(Required):

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Specific location:

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Building, Room number, Address if off campus

Involved Parties

If you know any information about the person or people involved please indicate below, otherwise please leave blank. DO NOT INCLUDE YOURSELF.

Name or Organization

Select Gender

Select Role

ID Number

Phone number

Email address

Hall/Address

Description / Narrative

Please provide a description of the incident/concern. All parties involved should appear in the narrative section below. If you have video, photos, or other documents those can be uploaded near the end of this report. Details regarding any threats of harm to self or others, dates and times, specific behavior or verbal statements are helpful. Please use direct quotes if known. Reports will be directed to the Bias Response Team for review. Again, if you are concerned for the immediate health and safety of yourself or others, please call University Police at 715.346.3456 or call 911.(Required) This field is required.

How was this information provided to you?(Required) This field is required.

This hate/bias incident targets: (Select all that apply)(Required)

Disability Gender/Gender Identity/Gender Expression National Origin Race/Ethnicity Religion Sexual Orientation Other

You must make at least one selection.

If you selected 'other,' please define: This field is required.

If known, describe the perpetrator(s) of this incident. This field is required.

How did this incident impact you? 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.

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Background Information

Involved Parties

Description / Narrative

Supporting Documentation

Submission