University of Wisconsin - Madison Logo

Bias Incident Report Form


This form is NOT a police report. This form is for reporting incidents of bias or hate. If you are in immediate danger, please call 9-1-1. The primary goal is to provide support to the individual or community impacted. However, reports will be evaluated to determine if further investigation is required for potential violations of University policy and/or criminal law.

Information obtained through these reports will assist UW-Madison in responding to and tracking incidents of bias or hate. The Dean of Students Office highly values privacy, and only crucial or emergency information is shared to appropriate contacts. Once submitted, the report goes directly to the Assistant Director - Bias Response and the Dean of Students Office Staff. In addition, the report will be seen by University Administrators in order to assess for campus climate issues.

Reports may be anonymous; however, anonymous reports may limit the University's ability to respond to the incident. Non-identifying information obtained from these reports will be posted on the Live Log located on the Bias Reporting Process webpage.

Please be aware that our reports may be subject to disclosure under Wisconsin’s Public Records Law. Names of students are confidential, but employee names and other information may be made public if requested. If you have any additional questions about the Public Records Law or are hesitant about reporting because of it, please contact reportbias@wisc.edu.

Background Information

 
Enable additional features by logging in.
Learn more
May be anonymous; this will limit the University's ability to respond
Learn more
(ex: student, staff, faculty)
Email address must be of a valid format.
This field is required.
This field is required.
This field is required.

Involved Parties (if known)

Include names of any known targeted individual(s), offender/respondent(s), and any witnesses.

Involved party 1

Questions

This field is required.
Were the police called? If yes, please indicate the agency and case number (if possible) in the Incident Description section above.(Required)
This field is required.
Was this incident reported to any other campus agency or department? If yes, please indicate where in the Incident Description section above.(Required)
This field is required.
Do you know who did this? If yes, please indicate who as the offender/respondent(s) in the Involved Parties section above.(Required)
This field is required.
Do you want the Bias Response and Advocacy Coordinator to contact you? If yes, you should include your name, phone number, and email address in the Background Information section above. Please note that by providing this information, our office will contact you if requested.(Required)
This field is required.
This field is required.
This bias incident targets:(Required)
You must make at least one selection.
This field is required.
Type of Incident:(Required)
You must make at least one selection.
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