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Bias Incident Reporting Form

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Bias Incident Reporting Form Report Bias! As an institution of higher education, Syracuse University fosters learning and growth. As a student of SU, you have an obligation to take an active role in fostering an appreciation for diversity and sending the message loud and clear that bias­ related acts will not be tolerated. Students who feel they have been the target of bias (or who have witnessed a bias­related incident) may report the incident online below, or contact the Office of Student Assistance at 443­4357, 306 Steele Hall, or the Office of Judicial Affairs at 443­3728, 310 Steele Hall. This is NOT for 911 or Emergency Service Do not use this form to report events that present an immediate threat. If you require emergency assistance, please call the Department of Public Safety at 315­443­2224, #78, or 911. Your confidentiality and trust is very important to us! We will make every effort to respect your privacy. Please be aware, however, in certain circumstances involving safety or criminal action, we may not be able to guarantee anonymity. Your contact information is optional and only necessary if you would like follow­up/feedback. Please use 'anonymous' in the name field if you wish to remain so. Background Information Your full name: Or, you may write Anonymous Your position/title: Your phone number: Your email address: Your physical address: * Your role: Urgency of this report: N/A * Date of incident: must be formatted YYYY­MM­DD Time of incident: : * Location of incident: Please select a location ... ===[PLEASE SELECT ONE]=== Off Campus Online Email Print Acacia Fraternity House Allibrandi Center Alpha Chi Omega Sorority House Alpha Chi Rho Fraternity House Alpha Epsilon Phi Sorority House Alpha Epsilon Pi Fraternity House Alpha Phi Sorority House Alpha Tau Omega Fraternity House Alpha Xi Delta Sorority House Archbold Gym Baker BBB Garage Bird Library Boland Bookstore Booth Booth Garage Bowne Bray Brewster Brockway Butterfield Carnegie LIbrary Carrier Dome Crouse Hinds Adm Crouse Hinds VPA Day DellPlain Delta Chi Fraternity House Delta Delta Delta Sorority House Delta Gamma Sorority House Delta Kappa Epsilon Fraternity House Delta Tau Delta Fraternity House Drumlins Eggers Ernie Davis Faculty Center Flanagan Gym Flint Gamma Phi Beta Sorority House Goldstein Student Center South Campus Haven HBC Hendricks Heroy Hinds Hall of Languages Hoople Huntington Illick Irving Garage Kappa Alpha Theta Sorority House Kappa Kappa Gamma Sorority House Kimmel/Marion Law School Law Library Lawrinson Lawrinson Garage Link Lyman Lyons Manley Field House Marshall Hall Marshall St Marshall St Gym Marshall Street Mall Maxwell Moon Library Newhouse Outside on SU campus grounds Park Point Phi Gamma Delta Fraternity House Phi Kappa Psi Fraternity House Phi Kappa Theta Fraternity House Phi Sigma Sigma Fraternity House Physics Pi Beta Phi Sorority House Pi Kappa Alpha Fraternity House Psi Upsilon Fraternity House Sadler Schine Sci Tech Schafer Shaw Sheraton Sigma Alpha Epsilon Fraternity House Sigma Alpha Mu Fraternity House Sigma Chi Fraternity House Sigma Delta Tau Sorority House Sigma Phi Epsilon Fraternity House Sims Skybarn Skyhall I Skyhall II Skyhall III Slocum Slutzker Smith South Campus Apartment South Campus Steele Tau Kappa Epsilon Fraternity House Tennity Theta Chi Fraternity House Tolley UC­University College University Ave Garage University Village Walters Warehouse Washington/Walnut Watson Whitman School of Management Women's Bldg Zeta Beta Tau Fraternity House Specific location: Reason(s) for Report Below are categories that correspond to the types of bias incidents. Check all that apply. TYPE OF INCIDENT Bullying Intimidation Pursuit/chase Discrimination from campus Offensive classroom comment Sexual assault office Offensive visual representation Sexual harassment Discrimination/policy from Other ­ Incident Threat of physical attack Faculty Phone harassment Vandalism Email or internet message Physical attack Verbal assault Hazing Property damage/graffiti Written slur Inappropriate verbal comment Indecency/exposure TYPE OF BIAS (Dis)ability Nationality/immigration status Sexual orientation/perceived Age Other ­ Type sexual orientation Ethnicity Physical appearance Socioeconomic status/class Gender identity/expression Race Unknown Gender/perceived gender Religion Veteran status Involved Parties INDIVIDUALS INVOLVED Please list names (or 'anonymous' or 'unknown'), gender (if known), and role in incident of ALL involved and impacted, including yourself. Please disregard the DOB field. SID = SU ID number, if known. Name or Organization ====[Select Gender]==== ====[Select Role]==== ID Number DOB (YYYY‑MM‑DD) Phone number Email address Hall/Address Add another person Description / Narrative DESCRIBE INCIDENT Please describe what happened in as much detail as possible. Check Spelling & Preview Additional Questions * Have you reported this incident to DPS? Yes No I plan to In your opinion; how could this be resolved? If needed; what is your preferred method for follow­up on this report? ===PLEASE SELECT ONE=== Supporting Documentation Photos, video, email, and other supporting documents may be attached below. Maximum 12 megabytes per file Attachments require time to upload, so please be patient after you click to submit this report. Choose File No file chosen One last step ... Help us prevent spam reports. Prove you're a human by typing the letters and numbers as you see them in the block to the right. Capitalization does not matter but cookies must be enabled in your browser for this to work. I can't read it; let's try a different one. Type it here: Submit report.
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