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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.

By submitting this form, I am indicating that I understand and agree that the information I have provided may be disclosed when and if necessary to ensure the safety of the members of the college. However, any information that is shared will be done with the utmost respect for privacy and sensitivity. In lieu of your signature, the submission of this form will indicate your agreement with this declaration.

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