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 is not included in the Index.

/ Approximate Time* :

Personal Information (REQUIRED).  The following information will remain confidential and will not be included in any summary posted on the Index. Anonymous reports will not be posted on the Index. Please provide this information about yourself so we can follow-up with you in a confidential manner. 

Last* Email* Cell Phone*

Last   Email   Cell Phone  

Last:  Email:   Cell Phone:  

Last:  Email:  Cell Phone:  

* denotes a required field