Bias Incident Report

Background Information

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Your full name:

Your phone number:

Your email address:

Date of incident(Required):

This field is required.

Time of incident:

Involved Parties

Name or Organization

Select Gender

Relationship to SSU

Questions

What type of incident are you reporting? (Select all that apply)(Required)

Graffiti

Vandalism

Verbal aggression

Physical aggression

Social media posting

Other

You must make at least one selection.

If other, please specify. This field is required.

Where did the incident take place?(Required) This field is required.

Please describe the incident.(Required) 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.

Background Information

Involved Parties

Questions

Supporting Documentation

Submission