Caption Arrow

Bias Incident Reporting and Form

A bias incident refers to behavior that is hostile, harassing, intimidating, offensive or discriminatory based on actual or perceived protected classes such as race/ethnicity, religion, gender and/or disability.

What Should You Do If a Bias Incident or Hate Crime Occurs?

  1. If you are injured, or fear immediate physical harm, call 911 or Campus Safety at 403-3299.
  2. Document (what, who, where and when) as much as possible.
  3. Contact the Bias Incident Response Group (BIRG) for assistance, or contact Corday Goddard at corday.goddard@snc.edu or 403-1351.
  4. Use the form below to share a bias incident that you have seen or experienced. It can be anonymous.
(*) indicates a required field

Bias Incident Reporting Form
*Name:
You can write in "anonymous" if you do not wish to disclose your name.
Phone number:
Email address:
Gender:  Male
 Female
 Transgender
 Another identity, please specify: 
*Primary status:  St. Norbert College Undergraduate Student
 St. Norbert College Graduate Student
 St. Norbert College Faculty
 St. Norbert College Staff
 Other, please specify: 
Incident Information
*Type of bias incident: Bullying (including social media)
 Hazing
 Intimidation
 Verbal harassment (e.g. offensive comments)
 Physical attack
Property damage
Other, please specify:
*I believe the incident was motivated by:

 (Dis)ability
 Age
 Gender
 Nationality/immigration status
 Race/ethnicity
 Religion
 Sexual orientation
 Other, please specify: 
Individual responsible for the bias incident:  St. Norbert College Supervisor
 St. Norbert College Faculty
 St. Norbert College Staff
 St. Norbert College Student
 Other, please specify: 
Location of the bias incident:

On campus (please specify):
Off campus (please specify):
 Online
 Unknown location

*Describe the nature of the bias incident:

If possible, please include the names of any witnesses.
Have you reported this incident to St. Norbert College Campus Safety?: Yes
No
Please specify if other offices have been contacted about this incident: 
*Upon receipt of this report, what do you want to happen?:  I would like to be contacted. Please note that you will need to provide your name and contact information above for us to contact you.
 I do not want to be contacted. I would like the report to be utilized by the college solely for informational purposes.
Please attach any supporting documentation. For example, image files or PDF documents.
*Declaration
  I understand that making an anonymous report of a bias incident (where I do not disclose my name), means that the information will be utilized by the institution to gain knowledge of the type of incidents that occur. In addition, I understand that the anony
Back To Top Arrow