Bias Incident Report

Please use this form to report electronically – and anonymously if you so choose - a bias incident that has occurred within the MU community.

If you have witnessed or experienced an act committed against any person, group, or property which you believe discriminates, stereotypes, harasses, or excludes anyone based on some part of their identity, please report it to the MU Equity Office using this form.

Identity may include race, color, ethnicity, religion, disability, nationality, language, gender, sexual orientation, group affiliation, and other similar factors.

You may use this form regardless of the severity of the incident (i.e., any incident, including hate crimes, can be reported here).

However:

IF YOU ARE CURRENTLY IN A SITUATION WHERE IMMEDIATE MEDICAL, POLICE OR OTHER EMERGENCY SERVICES ARE NEEDED – CALL 911 or MU Police at 573-882-7201 (on campus) or Columbia Police at 573-874-7652 (off-campus).
If the incident you want to report relates to a violation of the University's commitment to intellectual pluralism, please report the incident to the Provost's Office of Students Rights and Responsibilities using the form designed specifically for that purpose. If appropriate, the Associate Vice Provost will refer the matter to the Equity Office for follow-up.

1) What transpired during the incident? Please check all that apply:

*If other, please specify:

2) What type of bias occurred?

*If other, please specify:

3) In the following text box, please describe the incident as completely as possible.

Provide all relevant description, including dates and times; location; who was there, and, if known, whether participants are faculty, student, or staff; what the sequence of events was; what if anything was said; what action was taken and whether other appropriate officials have been notified; etc.

4) Association with the incident

5) Affiliation with MU

*If other, please specify:

Note: the identifying information below is optional.

If you provide your contact information, we will contact you to follow-up on this report.

Name:

Local Address:

Phone Number:

E-mail:

You may always report a bias incident in person or contact the Director of MU Equity directly to receive information, assistance, or referrals. You can reach Noel English at 573-882-9069, or via e-mail englishno@missouri.edu.

Clicking "Send" below will submit this report via an anonymous email.

Bias Incident Report

1) What transpired during the incident? Please check all that apply:

2) What type of bias occurred? Select One Age Disability Ethnicity/Race Gender Nationality Religion Retaliation Sexual Harassment Sexual Orientation Veteran Other

3) In the following text box, please describe the incident as completely as possible.

4) Association with the incident Select One Victim Witness Other

5) Affiliation with MU Select One Student Faculty Staff Alum Parent Visitor Other

If you provide your contact information, we will contact you to follow-up on this report.

2) What type of bias occurred?

4) Association with the incident

5) Affiliation with MU