Beloit College Hate Acts and Bias Incident Online Reporting Form
Beloit College takes hate acts and bias incidents seriously and will respond as swiftly as possible when such acts or incidents are reported.

If you have experienced hate or bias, use this form to report it; your report will be sent to the lead hate and bias responders.  All reports will receive some type of follow up, as outlined in the Anti-Hate Acts and Bias Incident Policy (https://www.beloit.edu/inclusive/bias/).
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Contact Information
Reports may be made anonymously; however, anonymous reports are likely to limit the college’s ability to respond to the incident.  [Please note that knowingly false reporting of hate and bias incidents is also subject to disciplinary action.]
Your Full Name
Your Phone Number
Your Email Address
Date & Time
Date of Incident *
MM
/
DD
/
YYYY
Time of Incident
Time
:
Effects and Support
Did this incident have a direct impact on you? *
Do you or anyone involved wish to receive support from college staff or faculty as a result of this incident?  If so, please comment what support you seek.
Involved Parties
Indicate names of any individuals involved in the incident, if known.
Indicate names of any witnesses, if known.
Incident
Please describe the incident with as much detail as possible. *
Location of Incident *
This hate/bias incident targets (please check all that apply): *
Required
In what ways did you, or anyone else, seek to intervene at the time the hate/bias incident occurred? *
Was Beloit College Security notified? *
Were the police called? *
Was this incident reported to, or discussed with, anyone else on campus, including other campus departments/programs/offices? *
Please add any additional comments, information, or observations you wish to share.
Additional Documentation
If you have any documentation of the incident (e.g., photos, emails, video, other documents, etc.), please forward them to either:
   • Cecil Youngblood <youngblc@beloit.edu>
   
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