Bias Incident Report
Directions:
IF YOU ARE CONCERNED ABOUT THE IMMEDIATE HEALTH AND SAFETY OF YOURSELF OR SOMEONE ELSE, CALL 911 OR VUPD AT (219) 464-5430.

A “bias incident” is any act that appears and/or is perceived by the targeted person(s) to be motivated by hostility toward one or more of their identities (i.e., race, religion, nationality, sex, disability, gender identity or expression, sexual orientation). A bias incident does not need to rise to the level of a violation of university policy or the law to be addressed. Please use this form to report an incident of bias that has an impact on you or a member of the Valparaiso University community.

DISCRIMINATION, HARASSMENT, AND SEXUAL MISCONDUCT COMPLAINTS:
If you have witnessed, experienced or are otherwise aware of sexual misconduct, discrimination/harassment based on sex, gender, gender identity, sexual orientation, or other violations of the University’s Non-Discrimination, Harassment, and Sexual Misconduct Policy, you must report such incidents directly to Julie Miceli, Interim Title IX Coordinator by completing this form https://goo.gl/forms/w9mV2kCunO5jTqLF3.

CONFIDENTIALITY:
If you choose to remain anonymous, none of your personal information will be recorded. If you choose to identify yourself in a reported incident, Valparaiso University will strive to protect the confidentiality of those individuals named in a reported bias incident and of those involved. However, the University reserves the right to investigate all reported incidents and take corrective action when warranted. While the University cannot guarantee complete confidentiality, personal information will only be shared with individuals with a legitimate need to know.

The Bias Incident Response Team (B.I.R.T.) is a university-wide committee made up of faculty, staff and administrators.

SPECIAL NOTE: The sentence below only applies if you upload files/photos/etc. If you are just submitting the form anonymously, your Google account identifiers (eg. email, username) will NOT be recorded.

Next
Never submit passwords through Google Forms.
This form was created inside of Valparaiso University. - Terms of Service - Additional Terms