As you complete the Bluffton University Bias Incident Report form, we ask that you fill in all fields as completely as possible. Remember to record only factual information as witnessed by yourself or others. Once you have completed all fields, hit the submit button on the Finish tab.  All information will then be sent to the Director of Community Life.

If you have questions or concerns, feel free to contact Director of Community Life at 419-358-3376.

Your name (optional):

Phone (optional):

Email (optional):

Date of Incident:

Time of Incident:

Location of Incident:

Room #:

Other location description:

Names of parties involved (please include first and last names):

Reason for report (select all that apply):

Other Reason:

Exact description of Incident (please be as detailed as possible):

Number of files to be uploaded to be submitted as evidence:

Upload a document to be submitted as evidence (e.g. text messages, social media posts):

Upload a document to be submitted as evidence (e.g. text messages, social media posts):

Upload a document to be submitted as evidence (e.g. text messages, social media posts):

By submitting this form, I acknowledge that the above information is accurate. I also acknowledge that all information will be sent to the Director of Community Life for review.