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Bias Incident Reporting Form


IF YOU NEED TO REPORT AN EMERGENCY, CALL THE WICHITA STATE UNIVERSITY POLICE AT 316-978-3450, or DIAL 911 IMMEDIATELY.

Please use this form to report an incident to Wichita State University's Bias Incident Response Group. This form can be completed by either victims of bias-related incidents, witnesses to them, or those indirectly impacted by them (e.g.family and friends). Include as much detailed information as possible.

You may choose to submit this form anonymously; however, not identifying yourself can limit the University's ability to respond to this report, including providing the necessary support to impacted individuals. Therefore, we ask that you include your contact information when submitting a report. All reports will be kept private to the fullest extent possible by federal and state law. Wichita State University strives to honor the wishes of Reporters, but they may need to take additional actions to protect the health and welfare of impacted individuals and the broader University community.

To report an on campus incident directly to the police please call Wichita State University Police at 316-978-3450. To report an off campus incident to the police please go to this page which discusses how to Report a Crime.

Reporter's Information

While anonymous reports are accepted, you are STRONGLY encouraged to provide your name and contact information in order to allow us to most effectively and efficiently address the concerning behavior.

 
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Involved Parties

Please list all of the involved individuals, organizations, and/or groups. Please consider the following when identifying the role of each involved person:


Impacted Person(s) - Those who are directly harmed by the actions or speech of a Responsible Person.


Affected Person(s) - Those who consider themselves or there community to have been indirectly harmed by the actions of speech of a Responsible Person.


Responsible Person(s) - Those whose actions or speech have harmed others or the community.


Supporting Person(s) - Friends or family of either the Impacted Person(s) or the Responsible Person(s).

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Incident Information

Please respond to the questions below to the best of your ability.

Type of Incident (Check all that Apply)(Required)
You must make at least one selection.
Type of Bias (Perceived or Confirmed, Check all that Apply)(Required)
You must make at least one selection.
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Was a specific person or group targeted?(Required)
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Duration of Behavior(s):(Required)
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Has this behavior/incident been reported to law enforcement?(Required)
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University Response - Incidents to report as "information only" would include hearing insensitive remarks or language not directed at an individual or group, noticing certain trends of bias that have not targeted a specific individual or group, etc. Please note that if a report is marked as "information only" there may be no follow up made to the reporter.(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