Bias Incident Report-All Campuses

Background Information

By sharing your contact information, staff have the opportunity to contact you to clarify facts or the context of your concerns. Thank you for helping us respond and prevent this behavior in the future.

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Your full name:

Your affiliation with UWGB:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

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(ie. academic building, residence hall building location)

Involved Parties

Involved parties would be anyone who was involved in the act, a victim of the act, or a witness to the act.

Name or Organization

Select Gender Pronouns

Role of Person

Phone number

Email address

Hall/Address

Questions

Supporting Documentation

Supporting documents could be emails, social media posts, pictures, videos or scanned documents. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission