Online Referral

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Type of Referral/Report

Choose from the following options below to help us route the referral to the appropriate resources.
Report Type(s)Required
Bias Incident Report

Indiana University Bias Incident Report

This form is for reporting incidents of bias. The primary goal is to provide support to the individual or community impacted. However, reports will be evaluated to determine if further investigation is required for potential violations of university policy and/or criminal law. If you are in immediate danger, please call 9-1-1.

Please remember that the timing and manner in which the university addresses this report will vary depending on the information provided and whether involved parties are available for further discussion.

Faculty and staff who experience bias incidents report here.

Please indicate the type of bias incident from the list below. Check all that apply.
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Please indicate the nature of the incident from the list below. Check all that apply.
If Other was chosen on any item above, or if you wish to provide any clarifying details on your selection(s), please provide further information in the text box below.

Referral Description and Documents

This can be the date of discovery of the incident/situation. If time is not known, feel free to use an approximate time. If the incident referenced includes multiple dates/instances, please use the approximate first incident date/time.
   
Choose the best option from the list provided below
Please specify location details to include building names. In the text box below, please provide as much detail about the location of this incident as possible.
In the text box, please provide a detailed description of the incident or concern using as specific and descriptive language as you are able. If slurs or derogatory language were used against you or another person, please place that language in quotes so we know that it is a part of the incident you are reporting. Include what, when, where, how often, other persons who witnessed the behavior(s), and any other information you can provide.
Please provide any supporting file attachments here.
Drop files here to upload

Parties Involved

Please provide specific details about the parties involved in the incident you referred to in the text box above. Be sure to include: person or organization's name; role in incident (directly experienced the bias, expressed the bias, witnessed the bias), and any identifying information about them.

*If you, as the reporter, played a role as described above, please include yourself, email address or any other identifying information of any of the parties involved.

Other University Resources Involved?Required
Have you worked with another university office in addressing this issue?
Were The Police Notified?Required

Reporter Information

Please identify yourself. Note: Contact information is NOT required.
Anonymous Reporting AcknowledgementRequired

Anonymous reports are accepted and investigated to the extent possible. The response team will make every effort to review and address the concerns submittted. However, without adequate information, the university cannot respond as effectively. Therefore, your contact information is strongly encouraged. Your report is completely confidential.

Thank you for helping to keep our campus safe.

Preferred Method of Contact
A staff member may contact you; which is your preferred method of contact?

Verification

Thank you for completing this online referral form. After completing the verification tool below, hit the SUBMIT button. Allow the screen to fully process and reload before closing the browser/tab. You will be taken to a confirmation page when submission was successful. If you provided an email address, you will also get a receipt email when successfully submitted.