Bias Incident Response Form

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Bias Incident Report Form

Report Information

After completing, please scroll all the way to the bottom of the form and click Submit Form.

In case of an emergency, please call Framingham State University Campus Police: 508-626-4911.

Thank you for taking the time to complete this report. The university is committed to addressing incidents of bias, both on and off campus, and we appreciate your help in bringing these incidents to our attention. This form can be completed by either targets of bias-related incidents or witnesses to them. Please include as much information as possible. All reports will be kept confidential to the extent possible. You also have the option to file anonymously. If you wish to be contacted, please include your name and contact information at the conclusion of this form.

Submissions through this form will be received by members of the Bias Response Team, and they will contact you shortly.

Your full name, preferred name, or Anonymous:

Your position/title if employed by FSU:

Your phone number:

Your email address:

Your physical address:

Were you a target of this incident or a bystander/witness to this incident?

Date and time of incident:

Location of incident: (required)

(check all that apply)

Residence hall

Virtual space

Common space

Classroom

Other

Please use this space to provide additional information regarding the location of the incident:

Please list the individuals involved (including yourself first, if appropriate or if you choose) and provide as much information in the text box as you can. If the name/identity of the involved person or persons are not known to you, indicate that they are unknown to you:

Please provide details about the incident:

Who else, if anyone, has been notified about the incident?

Have you filed a Bias Incident Report involving the same person(s) in the past?

Have you experienced similar incidents to this one during your time at FSU (either reported or unreported)?

OPTIONAL: Please use this space to share additional information if you answered “Yes” to either of the previous two questions.

If you would like to be contacted for follow-up, please provide your name and the best way to reach you (phone, email, etc.) and the best time to contact you:

Where did you hear about B.R.T.?

If you are making this report anonymously, please share what outcomes you hope will result from this report:

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