Reporter Affiliation to IU(Required)
Please Choose...
Student Freshman
Student Sophomore
Student Junior
Student Senior
Student Graduate
Faculty
Staff
Parent/Guardian
Alumni
Community member
No IU affiliation
Unknown
Other
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What was the primary source of Bias in this Incident?(Required)
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Age
Disability (physical or mental)
Ethnicity
Gender
Gender Expression
Gender Identity
Marital Status
Nation of Origin
Political Ideology
Race/Color
Religion
Sex
Sexual Orientation
Veteran Status
Other (Describe in Narrative below)
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Nature of incident?
(Please indicate the nature of the incident from the list below. Check all that apply.)(Required)
You must make at least one selection.
How are you connected to this report?(Required)
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Directly Experienced the Bias
Witnessed the Bias
Supporting Individual(s) Who Experienced the Bias
Bias Concern Without Being Directly Impacted
Viewer (observed online, e.g. social media)
Other (Describe in Text Box below)
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Description of Incident or Concern
(In the text box, please provide a detailed description of the incident or concern using as specific and descriptive language as you are able. If slurs or derogatory language were used against you or another person, please place that language in quotes so we know that it is a part of the incident you are reporting. Include what, when, where, how often, other persons who witnessed the behavior(s), and any other information you can provide.)(Required)
This field is required.
Date of Incident
(This can be the date of discovery of the incident/situation. If the incident referenced includes multiple dates/instances, please use the approximate first incident date.)(Required)
Location of Incident/Concern
(Choose the best option from the list provided below)(Required)
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On Campus – General
On Campus – Housing
On-Campus Academic Building
On-Campus Classroom
Off-Campus Study Abroad
Off-Campus
Online
Public Transportation
Unknown
Other (Use Text Box Below to Provide Detail)
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Additional Location Information
(Please specify location details to include building names. In the text box below, please provide as much detail about the location of this incident as possible.)
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Person who exhibited the bias affiliation
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Student
Faculty
Staff
Parent/Guardian
Alumni
Community Member
No IU Affiliation
Unknown
Other
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Other University Resources involved?
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I would describe this incident as being:
Please Choose...
Anti-Asian
Anti-Black
Anti-Gay
Anti-Latine
Anti-Muslim
Anti-Native American
Anti-Semitic
Anti-Trans
Anti-White
Islamophobic
Xenophobic (Anti-international)
None of the above
Other
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How did you learn about the bias incident reporting form?
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Advisor
Professor
Friend
Residence Life Staff Member
Marketing posters or on social media
Presentation/Workshop
Google search
This field is required.