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Your name
E-mail
Phone number
Affiliation with Goucher College
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Student
Faculty
Administrator
Staff
Is this a new report or a modification of an existing report?
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New report
Modification of an existing report
Nature of bias being reported:
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Gender
Race and Ethnicity
Sexual Orientation
Religion
Ability
Gender Identity/Expression
National Origin
Military Status/Veteran Status
Age
Immigration Status
Social/Economic Class
Sex
Other
Date of the incident:
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Time of incident:
Location of incident (be specific):
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Description of the incident:
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Please include all pertinent facts, behaviors, comments, and gestures. How many people were targeted by the incident? What was their affiliation to the college? How many people were the perpetrators of the incident? What was their affiliation to the college?
Describe the perpetrator(s):
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If you don’t know the names of those involved, providing descriptive information is helpful. Please include any distinguishing characteristics, markings, and clothing of the individuals.
Did anyone witness the event?
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Yes
No
Name of witnesses (if known):
Please include any contact information available and how they are connected to the Goucher community.
Would you like someone to contact you?
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Yes
No
What is your association with this incident?
A victim to this incident
A witness to this incident
A friend or acquaintance who did not witness the incident
To your knowledge, was this incident reported previously?
Yes
No
If so, to whom?
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