Hate Crime/Bias Incident Web-based Report Form

IF YOU ARE DEALING WITH AN EMERGENCY SITUATION, PLEASE CALL 911, AND USE THIS FORM LATER.

*Please use this form to report any event that you believe to have been hate- or bias-motivated and that happened to you at Whitman or in Walla Walla. Your responses will be sent to us from this form without any identifying information, unless you choose to include such information in your answers.

**This form will be used as a record keeping device, unless the author specifies other intentions.

If you are using a public computer to fill out this form, please reboot the computer after you send the form. This will ensure that no record of this page remains in the browser. Clicking the "back" button in your browser will erase the contents of this form, so remember to click "submit" at the bottom when you've finished.

IF YOU WOULD LIKE TO REPORT A HATE CRIME IN PERSON IMMEDIATELY, PLEASE CALL CAMPUS SECURITY AT 527-5777.

Instructions:

1. Please write about what happened:

2. What date did this occur? Approximately what time did this occur?

: (Midnight = 12:00 a.m.; noon = 12:00 p.m.)

3. The person filling out this form is:

A friend or acquaintance of the perpetrator(s) who did not witness the incident

A victim of the incident
A witness to this incident
A friend or acquaintance of the victim(s) who did not witness the incident

4. How many people were targeted or attacked?

Were they (check all that apply):

Family member(s) of Whitman student/staff/faculty
Other

Whitman student(s)
Whitman staff
Whitman faculty

5. Please describe the perpetrators to the best that you know/remember

6. Where did the incident take place?

7. Please elaborate, if necessary, on why you believe this is a hate-motivated incident and what aspects of identity were being attacked?

Please mark any or all that may apply.

Race
National origin
Ethnicity
Immigration status

Gender/Transgender identity
Sexual orientation
Social/Economic class

Religion
Disability
Other (Please specify):

8. Was this incident reported to anyone?

9. If you would like a trained advocate from Allies Against Hate to contact you to follow up on this report, please enter your contact information below:

Thank you for completing this report. Your information helps us to track and respond to hate and bias on campus. Please take a minute to read it over and confirm your answers before you submit them.

After you click "submit report," a confirmation screen will appear on your browser. You may want to print this page so that you have a record of your report.

If you are using a public computer at Whitman, please be sure to reboot after you close your browser and log out.