Reporting Form for Bias Incidents, Harassment, Discrimination or Gender-based Violence

Reporting Party Information

Please note that while this information is not required, anonymous reports may significantly limit our ability to review a matter. Accordingly, please share any of the information below that you feel comfortable providing. If you are mandatory reporter, you may not submit an anonymous report.

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Your full name:

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Please share your name, as it appears in University records (if applicable)

Your position/title:

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If not an employee, please share if you are a student, vendor, campus guest, or unaffiliated.

Your phone number:

Your email address:

Email address must be of a valid format.

Nature of this report(Required):

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Date of incident(Required):

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For multiple dates or if unsure of date, you may simply list today's date.

Time of incident:

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If not applicable or unknown, you may leave this field blank.

Location of incident(Required):

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Specific location:

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Please provide further details of the location, if applicable

Involved Parties

Please provide the information below regarding the other parties involved in the incident to the best of your ability. If you do not know or prefer not to identify any of the requested information, you may proceed without providing that information. Please note that employees reporting as responsible employees must report all known information.

Name or Organization

Select Gender

Select Role

ID Number

Phone number

Email address

Hall/Address

Information Regarding Concern

Please provide a detailed description of the incident or concern to the best of your ability. Please also be sure to clearly describe which party engaged in the concerning conduct, which party was targeted/affected by that conduct, and describe the nature of that conduct. For clarity, please also use first and last names.(Required) This field is required.

If this report involves you, how would you like us to follow up with you?(Required)

Phone E-mail

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If you are submitting this report on behalf of others, are they aware?(Required)

Yes No Unsure N/A

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Supporting Documentation (Optional)

If available, please upload any documentation that may relate to the incident/concern described above. This may include copies of documents, e-mails, photographs, text messages, etc. Please also note that such documentation is not required, and may be submitted at a later time. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Reporting Form for Bias Incidents, Harassment, Discrimination or Gender-based Violence

Equal Opportunity & Title IX

Reporting Party Information

Involved Parties

Information Regarding Concern

Supporting Documentation (Optional)

Submission