Bias Reporting Form

Incident Information
  mm/dd/yy
If the date of the incident is unknown, please indicate when it was found.

If the time of the incident is unknown, please indicate when it was found.


Please be as specific as possible.


Verbal Assault    
Physical Assault    
Written Slur or Graffiti    
Threat of Physical Assualt    
Property Damage    
Phone Harassment    
E-mail or Internet Messages    
Threat of "Outing"    
Other    

Age    
Economic Background    
Ethnicity    
Gender Identity/ Expression    
Marital Status    
Nationality    
Race    
Physical or Mental Ability    
Religious Practice    
Sex    
Sexual Orientation    
Veteran Status    
Other    
Check all that apply.


Please provide as much detail as possible.

Yes    
No    


Yes    
No    
Please attach your photo(s) in an email to:  mariel@skidmore.edu 

Yes    
No    


Alleged Offender Information

If known, include name, physical appearance, etc.
Stranger    
Relative    
Supervisor    
Friend    
Classmate    
Roommate    
Instructor    
Acquaintance    
Co-Worker    
Other    

Your Personal Information

yes    
no    
In your opinion, how do you think this matter should be addressed by the College?