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Bias Incident Reporting Form


Virginia Tech is committed to providing an environment of work, study, and leisure/recreation for students, faculty, and staff that is free from all forms of harassment, intimidation, fear, coercion, and exploitation. Harassment may be directed at individuals because of age, color, disability, gender (including pregnancy), gender identity, gender expression, genetic information, national origin, political affiliation, race, religion, sexual orientation, veteran status, or any other basis protected by law. Any such behavior is reprehensible and subverts the mission of the university. It can threaten the careers, educational experience, and well-being of all members of the community.

Student Affairs is committed to creating and sustaining a community where every student can thrive. If you’ve had an experience that has negatively impacted your opportunity to do that, let us know. Students can report experiences of bias, harassment, and discrimination, as well as file a complaint, ask for advice, express a concern, or simply tell someone.

If this is an EMERGENCY situation, please call 911 or contact the Virginia Tech Police Department at (540)231-6411. Do not use this form to report events that present an immediate threat to health or safety.

Your Information

Please provide as much information as you feel comfortable in sharing.

 
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Please provide the location at which the incident took place.

Involved Parties

Please list all involved parties, if you know them.

Involved party 1

Questions

Please complete the following to the best of your knowledge:

What is the nature of the alleged bias? (Please check all the categories below that describe the incident.) We also strongly encourage you, in the narrative section below, to give 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.
What is the nature of the incident?(Required)
You must make at least one selection.
This field is required.
University Follow Up: Please indicate whether you would like a member of the Dean of Students staff to contact you further to follow up.(Required)
You must make at least one selection.
Has this been reported elsewhere?(Required)
You must make at least one selection.
This field is required.

Supporting Documentation

Please provide any supporting documentation that you would like us to review (pictures, files, etc.). 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission