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Campus and Community Index: Bias Incident Report

Use this form to report incidents for the Campus and Community Index. The appropriate staff member will follow-up with you after you submit this report. The identity of individuals who report an incident, if they provide contact information below, are not included in the Index.

Date (MM/DD/YYYY)

Approximate time of incident

Description of the Incident (please provide as much information as possible)

Optional

Consider providing information about yourself so we can follow-up with you in a confidential manner. The personal information will remain confidential and will not be included in any summary posted on the Index.

First Name

Last Name

Email

Phone Number