KWC Bias Response Intake Submission Form

"*" indicates required fields

MM slash DD slash YYYY
Incident Time
:
Reporting Party*
I am a*
RA/Faculty/Staff/Student
Incident Report Type*
Select all that apply
Person(s) Allegedly Involved
Name
Campus Address
Cell Phone
Student ID #
 
Press the + button to add more rows. Please include as much information as possible.
Witness(es) and/or Victim(s)
Name
Campus Address
Cell Phone
Student ID #
 
Press the + button to add more rows. Please include as much information as possible.
Please summarize what happened and any related facts or circumstances.
Drop files here or
Max. file size: 50 MB.
    If you have any files to upload related to the event, please upload it here.