This form may be used to report a bias incident and/or hate crime. The information collected on this form will help track the frequency and nature of bias incidents and hate crimes impacting students in the Suffolk University community. Online reports will be reviewed by the Dean of Students.

You may enter your name on this online form or you may report anonymously. Anonymous reporting, however, may impact the University’s ability to respond or pursue appropriate action against the alleged perpetrators.

* indicates required field

Date this report is made (month, day,year):*
Person providing this information:*
Name:
Cell Phone:
Status of the person providing this information:*
I am a:*
  I am a targeted student/victim
  I am a friend or acquaintance of the victim
  I am a friend or acquaintance of the perpetrator (committed the act)
  I am a witness to the incident
  I did not witness the incident
  Other Relationship (enter below)
 
Date the incident occurred (month, day, year):*
What time did the incident occur:*
Details:*
Where did the incident occur:*
Details:
At what building did the incident occur:*
Details:
How many people were targeted in this incident:*
Was a specific group targeted (name of group):*
How many perpetrators were involved in the incident:*
Please provide a detailed description of the perpetrators (including name if known, height, weight, race or ethnicity, age, student, faculty or staff, status unknown)*
Please describe what happened in as much detail as you can including times, locations, number and names of witnesses, targeted students or groups and what makes you believe the incident was hate-motivated:*
  Race
  Color
  National Origin
  Religion
  Sex
  Age
  Disability
  Sexual Orientation
  Gender Identity
  Gender Expression
  Genetic Information
  Veteran Status
  Other Identity (enter below)
 
  In person verbal
  Telephone call
  Mail
  Email
  Social media posting
  Graffiti
  Harassment
  Intimidation
  Vandalism of living space
  Vandalism of vehicle
  Vandalism of work or study space
  Vandalism of personal property
  Vandalism of a residence hall
  Vandalism of academic building
  Vandalism of administrative building
  Physical assault with weapon(s) (enter below)
 
  Physical assault without weapon
  Sexual assault
  Other Incident form (enter below)
 
If yes, to whom was the incident reported?:
Comments:
If yes, please provide your name, telephone number, or department and email address. You do not have to enter this information to file a report:

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