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Bias Incident Reporting Form


As an institution of higher education, The College of Environmental Science and Forestry fosters learning and growth. As a member of the of ESF community, you have an obligation to take an active role in fostering an appreciation for diversity and sending the message loud and clear that bias-related acts will not be tolerated. Students who feel they have been the target of bias (or who have witnessed a bias-related incident) may report the incident online below, or contact

This is NOT for 911 or Emergency Service
Do not use this form to report events that present an immediate threat. If you require emergency assistance, please call University Police at 315-470-6666 or 911.

Your confidentiality and trust is very important to us! We will make every effort to respect your privacy. Please be aware, however, in certain circumstances involving safety or criminal action, we may not be able to guarantee anonymity.

Your contact information is optional and only necessary if you would like follow-up/feedback. Please use 'anonymous' in the name field if you wish to remain so.

Background Information

 
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Please indicate the approximate/Actual date of incident. If multiple dates, indicate in narrative.
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Approximate/Actual Location of Incident. If more than one, please explain in narrative below
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Approximate/Actual Location of Incident. If more than one, please explain in narrative below

Involved Parties

Involved party 1

Questions

Below are categories that correspond to the types of bias incidents. Check all that apply. Please refer to the definitions contained on the Inclusion, Diversity and Equity website at www.esf.edu/ide.(Required)
You must make at least one selection.
Type of Bias (Perceived or Confirmed)(Required)
You must make at least one selection.
This field is required.
Is the alleged discrimination continuing?(Required)
This field is required.
Have you reported this incident to University Police or other law enforcement?(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