Incident of Bullying, Harassment, or Sexual Harassment Report Form
Before reporting an incident, please read the notes below carefully:

The purpose of this report is to inform the social work and discipline teams of incidents that are making scholars feel physically or emotionally uncomfortable or unsafe.


The social work and discipline staff take all information here reported very seriously. This means that we commit to trying to resolve the situation as quickly as possible. If you report information that is not true, it interferes with our ability to address bullying, harassment, or sexual harassment quickly and efficiently. If you are reporting something that you heard from someone else and did not see yourself, please note that carefully.

Directions:

Please include as much detail as you feel comfortable providing. This will help us to address the issues quickly and directly. Thank you for taking steps to make yourself and those in your community safe.

Your Name
By providing us with your name, you increase our ability to address the issues that you describe. But, if you do not wish to provide your name, just leave it blank.
Your answer
Role
Incident
Select the statement(s) that best describes what happened (choose all that apply):
Required
When and where did the incident take place?
Please provide as much information as possible.
Your answer
Name(s) of the perpetrator(s)
The scholar(s) directly or indirectly involved with bullying, harassing, or intimidating another scholar.
Your answer
Name(s) of the victim(s)
Your answer
Witnesses
Please include staff/scholar names
Your answer
Incident Description
Describe what you saw or heard and include as much detail as you feel comfortable sharing. Please also note if you did not witness something first-hand but rather heard about it from someone else.
Your answer
Additional Information
Please share any additional context regarding the situation and/or scholars involved.
Your answer
Submit
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