BGSU :: Student Life :: Bias Incident Reporting Form

Bias Incident Reporting Form

Thank you for completing the following survey! Your feedback is valuable as it helps provide information for evaluation and improvement of the discipline process at Bowling Green State University. All responses will be confidential and your identification will not be known. Please be honest in your responses.

Location of incident:	in a class in a campus office in a campus building while walking on campus at a campus event in a residence hall off-campus parking lot/structure other

Date incident occurred:

I believe the motivation of this incident was: (mark all that apply)	race ethnicity gender religion sexual orientation disability gender identity/expression retaliation age military/veteran other


The incident was directed at:	me other people both


Has this incident been reported to another BGSU office?	yes no I don't know

Is there any physical evidence?	yes no


The incident was: (mark all that apply)	verbal comment written/drawn phone harassment vandalism verbal intimidation physical intimidation assault


First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone:
Email Address:

Name of FIRST Violator, if known:
Address of FIRST Violator, if known:
Is the FIRST Violator a BGSU student, if known:	Yes No I Don't Know
Names of other violators:

Description of the incident:


Once submitted you will be transferred to the Dean of Students Homepage