Bias Incident Report Form

UIndy is committed to addressing incidents of bias, both on and off campus, and we appreciate your help in bringing these incidents to our attention. This form can be completed by either targets of bias-related incidents or witnesses to them. Please include as much information as possible. All reports will be kept confidential to the greatest extent possible. You also have the option to file anonymously, or report a bias incident in person to the Office of Inclusion and Equity, 201 Schwitzer Center. If you wish to be contacted, please include your name and contact information at the conclusion of this form.

Submissions through this form will be sent to oie@uindy.edu.

In the event of an emergency or to report a crime/ incident in progress, please call 911. When calling 911 from residence hall rooms or university offices, you must use the 9 prefix (9-911).

Policies, information and reporting procedures for gender discrimination or sexual misconduct can be found at: uindy.edu/campus-life/titleIX.

 

Your full name or preferred name

Your email address

Your phone number

What is your preferred method of contact?

Email
Phone

Your role at UIndy

Student
Faculty
Staff

Were you a target or a bystander/witness to this incident?

Target
Bystander/Witness

Date of Incident

Location of Incident (check all that apply)

Classroom
Common Space (i.e. library, student center, campus building, etc.)
Residence Hall
Other

Please use this space to provide more specific information regarding the location of the incident (i.e. name of building, etc.)

Please provide details about the incident