IU - Bias Incident Reporting

Reporter Information

Please identify yourself. Note: Contact information is NOT required.

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Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Campus(Required):

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Please choose the campus this concern relates to

Involved Parties

Please provide specific details about the parties involved in the incident you referred to in the text box above. Be sure to include: person or organization's name; role in incident (directly experienced the bias, expressed the bias, witnessed the bias), and any identifying information about them. *If you, as the reporter, played a role as described above, please include yourself, email address or any other identifying information of any of the parties involved.

Name or Organization

Select Role

University ID (if known)

IU email address (if known)

Incident Details

Reporter Affiliation to IU(Required) This field is required.

What was the primary source of Bias in this Incident?(Required) This field is required.

If Other, please describe below. This field is required.

Describe the Type of Bias? This field is required.

Other (Nature of Incident This field is required.

How are you connected to this report?(Required) This field is required.

How are you connected: Other This field is required.

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)

This field is required.

Location of Incident/Concern (Choose the best option from the list provided below)(Required) This field is required.

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.) This field is required.

Was there a Student Organization involved?(Required)

Yes No

This field is required.

Name of Student Organization (In the text box below, please share any identifying information about the Student Organization involved.) This field is required.

Person who exhibited the bias affiliation This field is required.

Other University Resources involved? This field is required.

Were the Police Involved?(Required)

Yes No

This field is required.

Police Notification Details (If known, please provide the agency name, officer name, and/or any other information.) This field is required.

Follow Up Contact (Follow up will be conducted via Email. Please identify if a phone call follow up is requested in addition.)(Required)

Yes (Contact me for additional information) No (No support or follow-up needed)

This field is required.

I would describe this incident as being: This field is required.

I would describe this incident as being: Other This field is required.

How did you learn about the bias incident reporting form? This field is required.

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.

Email me a copy of this report

Reporter Information

Involved Parties

Incident Details

Supporting Documentation

Submission