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Bias Related Incident Reporting Form


THE BIAS INCIDENT REPORTING SYSTEM IS FOR REPORTING NON-EMERGENCY INCIDENTS ONLY


FOR EMERGENCIES, INCLUDING SAFETY CONCERNS FOR MEMBERS OF OUR COMMUNITY, CALL UNIVERSITY POLICE AT (585) 395-2222, or DIAL 911


This form is intended to provide an opportunity for individuals to report concerns and incidents related to bias so The College at Brockport can further look into them and provide resources/support to the reporting individual(s).


If you experience difficulty and/or would like assistance completing this form, please contact the Office of Equity, Diversity & Inclusion at 585-395-5014 between the hours of 9 am - 4pm, Monday-Friday. Again, in cases of emergency, please call University Police (585-395-2222), or local law enforcement (911).


While the College takes all reports seriously, our ability to take action on anonymous reports, depending on the information that is shared, may be limited. The College does not guarantee a response to all reports submitted. Please know that campus safety is our utmost concern.


The information contained in this report will be shared with the appropriate University officials involved in any subsequent monitoring, investigation, or resolution of the incident. Again, as The College takes all reports seriously, please make your report as accurate and truthful as possible.


For more information about Diversity and Inclusion please visit:
www.brockport.edu/diversity

Additional Campus Resources:
Information about Academic Freedom: www.brockport.edu/support/policies/adopted/aa_academic_affairs_academic_freedom
Counseling Center: www.brockport.edu/cc/
University Police: www.brockport.edu/university_police/
Affirmative Action: www.brockport.edu/affirmative_action/
Employee Assistance Program: www.brockport.edu/hr/eap/
Student Conduct: www.brockport.edu/studentconduct/
Title IX: www.brockport.edu/titleix/
Human Resources: https://brockport.edu/support/human_resources/

Reporting Person Information

Please provide us any information you would like to share that will allow us to follow up with you regarding this report. Providing this information is not required if you wish to remain anonymous.

 
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Involved Parties

Please include names of any known individuals who were witness to, victims of, or participants in the incident being reported.

Involved party 1

Questions About Incident

1. What was the nature of this incident? Please select all that apply
You must make at least one selection.
2. Does the victim desire action against the accused individual(s)? Select all that apply.
You must make at least one selection.
3. What resources has the Victim utilized thus far? Select all that apply:
You must make at least one selection.
4. Are you open to being contacted by a College official?(Required)
This field is required.
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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