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Bias Incident Report Form


Members of the campus community who have been the targets of, or who witness, a hate or bias related incident may use this online form to make the University aware of these incidents. When reporting hate or bias incidents through this form, please also note we will make every effort to respect your privacy. However, please be aware in certain circumstances involving safety or criminal action, we may not be able to guarantee complete anonymity. Regardless of the situations, matters are generally handled discretely and in conformity with University policies. Information about individuals or situations will only be shared with those with a legitimate need to know.

This Reporting Form is NOT a 911 or Emergency Service:
Do not use this site to report events presenting an immediate threat to life or property. Reports submitted through this service may not receive an immediate response. If you require emergency assistance, please contact Kutztown University Police at 610-683-4001 or dial 911.

Your Information

 
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Involved Parties

Please list the individuals involved (including yourself, if appropriate) and provide as much information in the listed fields as you can. Witnesses should also be identified. For any person who is a non-student, please use the following format for the ID NUMBER FIELD with a maximum of 15 characters: LASTNAMEFIRSTNAME (e.g. Luke Skywalker = SKYWALKERLUKE).



If the name/identity of a person is unknown to you, please enter "UNKNOWN PERSON" as the name in this section and then describe the individual(s) in as much detail as possible below in your narrative.

Involved party 1

Incident Information

Please provide as much information as possible regarding the incident in question.

Type of Incident: Please check all types of conduct involved in this incident.(Required)
You must make at least one selection.
Type of Bias: Please check all the categories below that describe this incident. We also strongly encourage you to fully describe, in the narrative section below, all the details of the incident, including the reasons you believe the incident was motivated by bias.(Required)
You must make at least one selection.
Has this been reported to a police agency?(Required)
You must make at least one selection.
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.

Submission