Bias Incident Reporting Form

If you are in an emergency situation, contact the Emory Police immediately at 404-727-6111. Bias Support Services will be closed from December 22 to January 3, 2021. If you submit a report during this time, we will contact you, if applicable, after January 3. For urgent matters, please contact the Student Intervention Services Crisis On-Call Team at 404-430-1120.

Emory University values open expression and vigorous debate in the context of civility and mutual respect for diverse individuals and communities. We continually “practice” community by sharing our experiences, listening carefully to others, and debating ideas in civil, generous, and constructive ways. Bias incidents directly impact our ability to know, trust, support, and learn from one another.

The term bias incident refers to the use of language and/or actions that demonstrate bias (prejudice) against persons because of, but not necessarily limited to, their actual or perceived race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression, or status as a military veteran.

Bias incidents include, but are not limited to, name-calling, stereotyping, belittling, or excluding others based on their identity. Some, but not all, bias incidents may rise to the level of discriminatory harassment, sexual misconduct, or other violations of policy or law.

If you have questions about the Bias Incident Response Team, click here to visit the Bias Support Services webpage.

Date of incident Date of incident / MM / DD YYYY
Time of incident Time of incident : HH MM AM/PM
Location of incident

Please be as specific as possible
Did this incident take place on the Oxford College campus?

Did this incident take place on the Oxford College campus? No Yes
Describe the incident. If you are making an anonymous report, please provide as many details as possible.

Please summarize the facts in as much detail as possible. Describe all comments, conduct, gestures, physical injuries, property damage, etc. Identify the person(s) involved in the incident by name, if known, or by physical appearance. List any possible witness(es) by name and contact information, if known.
If you reported this incident to another university department, please include the date you reported it, who you reported it to (department and/or individual), and any response you received. If you did not report it to another department, leave blank.
Do you want to be contacted regarding this report?
If yes, please provide your contact information below, including name, phone number,
and e-mail address
Name Name First Last
Phone Phone - ### - ### ####
Email
Please indicate your affiliation with Emory University:

Please indicate your affiliation with Emory University: Undergraduate Student Graduate/Professional Student Faculty Staff Other (please describe) Other (please describe)
Please know the importance of preserving evidence until a staff person can respond. If you experience or witness a bias-related incident, please do the following to document the incident as best you can. If the incident involves a written slur or graffiti, do not erase the text. The police will need to see it. If you have a camera or cell phone camera, take a picture of any evidence, such as physical injury, damaged property, or a license plate.

If the incident is verbal, please write down or verbally record exactly what was said – to the best of your recollection and as soon as possible. Retain the contact information of any potential witnesses.

Again, please act immediately to preserve evidence; speed and accuracy of response are critical.

Upload a file here.

Attach Files

(e.g. screenshot of social media post or email)