Bias Report Form

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Bias Reporting

REPORT HOMOPHOBIA!

This page is designed to offer individuals who have experienced any form of discrimination or problems related to homophobic attitudes or action. 

IF THIS IS A MEDICAL OR POLICE-RELATED EMERGENCY,

PLEASE CALL 911

While information concerning the event is required, identifying information is completely optional.  Also, keep in mind that the more information you give allows us to better assist you.  And as always, please remember that all information given is confidential.

How can we contact you? (optional)



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Required Information Indicated with an Asterisk










(Please note that if you do not check this box, you will not be contacted by the LGBT Center, and all information will remain with the office)


Additional information optional

If you are the survivor of the incident, please complete the information below.  If you are an observer or the incident was reported to you, fill out as much information as you know about the survivor.





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