Chapel Hill-Chauncy Hall Incident and Bullying Report Form
Please use this form to report incidents. Please note that if you report your incident anonymously we will not be able to report findings or outcomes. 
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Do you wish to make this report anonymously? *
Name ( if you wish to remain anonymous please type "ND")
Email

Where did this experience occur? 

 *
Required
Date of Incident *
MM
/
DD
/
YYYY
Type Alleged Misconduct *
Required
Do you feel the behavior happened because of your (or affected party's) membership in any of the following protected classes (if yes, please select all that apply) *
Required
In your own words, please describe the incident that occurred as you experienced it or as it was described to you. If reporting a pattern of behavior or multiple incidents, please begin with the most recent and explain how the behaviors or actions relate to the category or categories checked above. *
Are you able to provide supporting documentation such as screenshots, text messages, etc? If so please print and place in Ms. Ts mailbox
Submit
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