Campus and Community Index: Bias Incident Report

Use this form to report incidents for the “Campus and Community Index.” The appropriate staff member will follow-up with you after you submit this report. The identity of individuals who report an incident are not included in the Index.

Date/Approximate Time of Incident*:




Personal Information (optional).  Consider providing information about yourself so we can follow-up with you in a confidential manner.  The personal information will remain confidential and will not be included in any summary posted on the Index.  

Last: Email: Cell Phone:

Last:  Email:  Cell Phone: 

Last:  Email:  Cell Phone: 

Last:  Email:  Cell Phone: 


* denotes a required field