Hazing and Discrimination Reporting Form
                                                          IF THIS IS AN EMERGENCY CALL 911

This form is for incidents related to bias, microaggressions, discrimination, or hate aimed at or committed by a member of the Grace community based on a protected class, status, identity, or a perceived class, status or identity.

This form can also be used to report incidents of hazing. 

If you have been the target of or witness to hazing or bias, please report the incident below.

This form is NOT for emergencies that present an immediate threat. If you require emergency assistance, please call 911 or call the Campus Safety Department at (574) 269-5344.

Notices can be submitted anonymously, and Grace will do its best to investigate even without your contact information. You will be asked to sign in to your Google Account to use and fill out this form, but your username and email will not be recorded. Please be aware that in circumstances involving safety or criminal action, we may not be able to guarantee anonymity.

A decision to remain anonymous may limit Grace's ability to stop the alleged conduct, collect evidence, take action against parties alleged to have violated this policy, or follow up with you.

The Administration and Compliance office receives the information you report and may contact you for more information and to ensure your safety. Do the best you can to complete all fields below so that your notification can be forwarded to the office responsible for investigating or responding to your report. No question is required, and we ask that you provide as much detail or information as possible.

NOTE: You may also notify the following offices:
  1. Campus Safety: (574) 269-5344
  2. RD on call: (574) 635-5737
  3. Associate Dean of Mentoring & Cross Cultural Engagement: (574) 372-5100 x6477
  4. Title IX Coordinator: (574) 372-5100 x6491 (McClain 102)
  5. Coordinator of Disabilities Services: (574) 372-5100 x 6423
(updated 8/25/25)

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Your full name.
I am:
Clear selection
Are you the harmed party?
Clear selection
Phone number where you can be reached.
Email address where you can be reached.
May we contact you for additional information?
Clear selection
What best describes the nature of this notification?
What information would you like to share about the hazing or harassment that happened?
What has been the impact of the hazing or the harm to the harmed party?
Date(s) of incident.
Time(s) of incident.
Address or specific location of the incident.
What help or resolution you are requesting, if any. If not, type N/A.
Has this been reported to any of the following?
If there is any other information you would like us to know to help us understand the situation, please include that here.
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