Bias Incident Report Form

If you need immediate assistance or intervention, please contact the Office of Campus Safety at (315) 792-3046 or 611, or call 911.

Please note: This form simply helps you to inform Bias Response Referral Network (BRRN) of what has happened and, if you wish, to ask for assistance. This form:

  • Does NOT connect you to emergency or immediate help;
  • Is not a substitute for emergency services;
  • Will not automatically notify the Office of Student Conduct and Community Standards, the Office of Campus Safety, the Office of Human Resources (if a workplace incident) or law enforcement about this incident. If you have already made a report in any of those places, please indicate that when you fill out this form.
  • The BRRN will review your report and, if you provide us with contact information, will reach out to you within 72 hours.
  • After talking with you about options, we will ensure you have information about resources and support, and make the appropriate referrals and/or connections for any action that will be taken.

Items marked with a red * are essential information so that we can understand your concern and what has happened in order to respond most effectively. Please give us as much information as you can.

Contact Information
Do You Wish To Be Contacted? *

If you wish to be contacted, you must enter your e-mail address and/or phone number below.

Your confidentiality and trust is very important to us. We will make every effort to keep the information you provide about yourself or others involved in this incident as private as possible. Please be aware, however, in certain circumstances involving safety or criminal action, we may not be able to guarantee complete anonymity. If at any point we need to share personally identifiable information to maintain the safety of individuals or the College community, or it is required in order to move forward with a conduct process or investigation, we will make every effort to talk with you first. In those situations, information will be shared only with individuals with a legitimate need to know.

Please note that if you choose to make this report anonymously, our ability to respond to the incident you report will be limited. Anonymous reports also limit our ability to provide you with support and resources that might be helpful to you in the future.

We will, however, keep a record of all reports in order to maintain a more accurate record of bias-related acts and hate crimes that occur in our community.

Background Information
Please check all that apply
Involved Parties, if known *

While you may choose to make this report anonymously, it will be helpful to our understanding of what happened if you provide information not only about yourself but about any other individual(s) who may have information regarding the incident.

To the degree that you are able to do so, please provide names, contact information, and information about that individual’s role in the incident (target of the behavior, witness, person engaging in the behavior, etc.)

Add Another Involved Party

Information regarding the bias related incident or hate crime
Supporting Documentation
Photos, video, email, text, campus safety report, and other supporting documents may be attached below. Attachments require time to upload, so please be patient after you click to submit this report.

Add Another Document

Resources

Additional Resources

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For a general list of frequently used logins, you can also visit our logins page.