Racial Bias and Discrimination Reporting Form

Background Information

Please complete the following items to the best of your ability. Providing more information will improve the University's ability to appropriately respond to your report. If you are a third-party reporter who is not the person experiencing discrimination or harassment, include their name and contact information in the involved parties section below.

Your full name:

Your position/title:

Your phone number:

Your email address:

Approximate date of incident(Required):

This field is required.

Approximate time of incident:

Location of incident(Required):

This field is required.

Specific location description:

Involved Parties

Involved Party Name or Org.

Select Role

ID Number (if known)

Phone number (if known)

Email address (if known)

Campus/local address

Questions

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.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission