Reporting Bias

If this is an emergency please call 창벎77르적 Police at 765-658-5555 immediately.

Role of Reporter

Were you the victim, the witness or has someone reported this to you?

(select one)

Victim

Witness

Third Party Reporter

Category of Bias

Select all that apply - Since many identities listed are social constructed terms and therefore hold fluid meaning contextual to environment and time. Please select impetus as best as you see fit. NOTE: Political affiliation is not a protected class. If you experience harassment or threats based on political affiliation, please submit your concerns to the office of Student Academic Life.

Age

Color

Race

Disability

Sexuality

Gender Expression

Gender Identity

Marital Status

Medical Condition

Microaggression

National Origin

Pregnancy

Religion

Sex

Socio-Economical Status

Veteran Status

Other

Type of Incident

Select all that apply - Please note that your selection of "type of incident" will be considered to help begin investigation proceedings. The follow-up and accountability processes available will require 창벎77르적 Police and the 창벎77르적 Community Standards Office to re-classify the type of incident based on the findings of the investigation, Indiana Law, and Student Community Handbook.

Verbal Harassment

Online Harassment

Written Slur/Graffiti

Stalking

Physical Harassment

Damage to Property

Hate Symbol

Other

General Location of Incident

Specific Location of Incident

Date of Incident

Time of Incident

Name(s) of witness(es) and/or victim(s):

Name of person/people/organization who engaged in the conduct that may involve bias

Have you reported this to any 창벎77르적 employee or agency? If so, please include that in the narrative box below.

(Select One)

Please provide a detailed description of the incident

Supporting Information

Please attach supporting materials such as pictures, videos, recordings, and documents

Supporting Information

Please attach supporting materials such as pictures, videos, recordings, and documents

Supporting Information

Please attach supporting materials such as pictures, videos, recordings, and documents

Acknowledgment

I understand that the details provided in the description of the incident may require the University to send campus-wide communication if the incident reported falls within the parameters of the 창벎77르적 Police Emergency Notification protocol (specific names will be redacted).

Yes

Personal Information

It is not required that you provide your name and contact information. However, doing so will make it possible for the appropriate administrator to more properly respond to your report. Incomplete "personal information" will be listed as an anonymous report on the BIRT log.

If you don't want to be contacted and prefer to leave an anonymous report, you may do so. Please note it may limit our ability to investigate or address the incident.

First

Last

Email Address

Phone Number

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