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Hate/Bias Incident Reporting Form


If you or someone you know has witnessed or been the target of a hate/bias incident, you may bring the incident to the attention of the Diversity Advocacy Team by completing this form. The purpose of this reporting form is to identify the occurrence of hate/bias incidents both on and off-campus. 

A hate/bias incident is any physically or verbally harmful act that is motivated by (or appears to be motivated by, in whole or in part) any of the following factors: race/ethnicity, religion, national origin/immigration/citizenship status, sex, sexual orientation, gender identity or expression, economic status, language, age, size, pregnancy or family/marital status, disability, veteran or military status, or any other identity status protected by Western.

Incidents of hate/bias are taken seriously at Western Technical College. Every person has the right to a safe living and learning environment.

Please complete the form with as much information as you choose. Completing this form is an important step to help us understand the campus environment and how we can respond appropriately to create a climate where everyone feels welcome.

This is an informal report; however, we reserve the right to forward the information to one of our formal reporting structures if deemed necessary. 

If there is an immediate risk or threat to safety, security, or health
CALL 9-1-1 IMMEDIATELY
Then call Security at 608-785-9191



To report a Student Code of Conduct violation, please submit it here or contact the Student Life Office at 608-785-9445.

Person Reporting Incident Information

If you wish to be contacted for a follow-up or to discuss the incident further, you will need to complete the following information. Please note that the information will be kept confidential to the fullest extent permitted by law and policy.

 
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Email address must be of a valid format.
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(Ex. 1st floor women's restroom)

Individuals Involved

Please list all individual(s) involved and/or impacted by the incident. Please include as much information as possible for each individual. If the individual(s) is unknown or you do not wish to disclose, please type "Unknown"

Involved party 1

Questions

Please take a moment to answer the questions below. First, please provide us with some more specific information about the incident and about the person(s) who may be involved. Second, please provide us with some additional information about you so that we can provide support or connect with you to learn additional information.

Please indicate the type of incident (check all that apply):
You must make at least one selection.
Please indicate the category of bias (check all that apply):
You must make at least one selection.
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What is your status at Western?
You must make at least one selection.
Would you like to be contacted to discuss this incident further? If "yes," please be sure you have provided your email or phone number, above.(Required)
You must make at least one selection.
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Supporting Documentation


Please attach any documentation that may be pertinent to the incident (ex. screen shots of online or text messages, photo of damage or graffiti, etc.)
5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission