Quinnipiac University Logo

Bias Incident Reporting Form


If you have been the target of discrimination, discriminatory harassment, or bias-motivated acts or behaviors (or have witnessed or heard about a bias-related incident), please report the incident below, and a staff person will follow up within three business days.

This form is NOT intended for emergencies or reporting immediate threats. If you require emergency assistance, please call the Department of Public Safety at 203-582-6200, or 911 from any campus phone.

Your contact information is necessary if you would like follow-up or feedback. Otherwise, you may enter 'anonymous' in the name field. Please be aware, in certain circumstances involving safety or criminal action, we not be able to guarantee anonymity.

The university will respond promptly and equitably to all anonymous reports, but the response may be limited due to lack of information.

Background Information

 
Enable additional features by logging in.
Learn more
student, staff, faculty
Email address must be of a valid format.
This field is required.
This field is required.

Individuals Involved

Please list names (or 'anonymous' or 'unknown') and role in incident of ALL involved and impacted, including yourself.

Involved party 1

Questions

Below are categories that correspond to the types of bias incidents. Check all that apply.

TYPE OF INCIDENT(Required)
You must make at least one selection.
TYPE OF BIAS (PERCEIVED OR CONFIRMED)(Required)
You must make at least one selection.
This field is required.
This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission