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Discrimination, Harassment, Bias-Related Incidents & Hate Crimes Reporting Form
Thank you for reporting this sensitive information. A professional staff member will reach out to you soon to discuss next steps, as well as options for support and resources. Please note that you have options and filling out this form does not automatically initiate a formal complaint. We look forward to supporting you and helping you navigate this difficult situation.
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Today's Date
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MM
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DD
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YYYY
Name of Student Complainant
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Your answer
Name of Person Filling out this Form (if different than complainant)
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Your answer
Student Email
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Your answer
Student Cell Phone Number
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Your answer
Student Mailing Address
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Your answer
Student ID Number
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Your answer
Student Status
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Undergraduate
Graduate
Adult Degree
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Other:
Name of Responding Party (list all if it's more than one person)
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Your answer
Date of the Incident
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MM
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DD
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YYYY
Location of Incident
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Your answer
Briefly describe the Nature of the Incident
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Your answer
Any other information you want us to know?
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