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Bias Incident Report Form

Bias Incident Report Form

Please use this form to document and report bias-related behaviors or actions to the McNeese State University Bias Incident Response Team. This report can be submitted by individuals directly affected by bias-related behaviors or actions, by observers of these behaviors or actions or by those indirectly impacted (advisor, family members, friends).
(Check all that apply)
Please select the number that best represents the level of severity of this incident with 5 being the highest level.
Please categorize the type of bias for this incident.
(Check all that apply)
Was the Police Department called or otherwise involved in this incident?
Were you satisfied with the response/action from the police department?
Was the incident reported to a campus official or department?
Incident Report
Include any information you have identifying the person involved. Please include name of person(s) and or groups(s), e-mail, contact phone number(s), and/or McNeese ID number(s).
Please describe what happened in chronological order using people's names whenever possible.
Please upload any information supporting the concerns in this report. This may be e-mails, video, photos, etc.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif txt rtf html pdf doc docx odt xls xlsx ods xml avi mov mp3 ogg wav.
Add more files:
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif txt rtf html pdf doc docx odt xls xlsx ods xml avi mov mp3 ogg wav.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif txt rtf html pdf doc docx odt xls xlsx ods xml avi mov mp3 ogg wav.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif txt rtf html pdf doc docx odt xls xlsx ods xml avi mov mp3 ogg wav.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif txt rtf html pdf doc docx odt xls xlsx ods xml avi mov mp3 ogg wav.
Add more files:
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif txt rtf html pdf doc docx odt xls xlsx ods xml avi mov mp3 ogg wav.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif txt rtf html pdf doc docx odt xls xlsx ods xml avi mov mp3 ogg wav.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif txt rtf html pdf doc docx odt xls xlsx ods xml avi mov mp3 ogg wav.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif txt rtf html pdf doc docx odt xls xlsx ods xml avi mov mp3 ogg wav.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif txt rtf html pdf doc docx odt xls xlsx ods xml avi mov mp3 ogg wav.
Reporter Information
Individuals reporting bias-related behaviors or actions may remain anonymous, however that may limit our ability to investigate or take appropriate action. Providing a way to contact you will be helpful if additional information is needed.