Bias/Discrimination/Harassment
Reporting Form

#New Form

THIS FORM IS NO LONGER IN USE
PLEASE GO TO THE FOLLOWING LINK FOR THE LATEST VERSION
https://esign.wwu.edu/admcs/forms/default.aspx?deptID=1004

 

You may use this form to report incidents of possible bias, discrimination or harassment such as graffiti or anonymous phone calls.  If you want to discuss the situation or request assistance, please call the EO/AA Office (360/650-3307) to set up an appointment with Equal Opportunity Staff.  If the incident involves assault, damage to University property, or other potentially criminal conduct, contact the University Police Department directly (non-emergency: 360-650-3555; emergency: 3911).  The Equal Opportunity Office may forward this report to the University Police if the incident appears to be a crime.
 
To report an incident, please provide information in the boxes below and click SUBMIT.
Date of Incident: Location of Incident: Time of Incident:
 
Description of incident (include information about any people known or suspected of being involved and their role).  Include any detail that make you believe that incident was bias motivated, such as what was said and/or done:
 
BASIS OF DISCRIMINATION (check any that apply):
Race/Color Age
   
Ethnicity/National Origin Disability
   
Religion/Creed Sexual Orientation
   
Sex (Including Gender Expression or Identity) Marital/Domestic Partner Status  Unknown
Veteran Status  
   
Other:
 
Name of Reporting Individual or Office:  Date:
 
Campus Address:  Phone Number:
 
Email Address:  
 
 
Would you like a confidential follow-up contact by a WWU support services staff member (Lesbian, Gay, Bisexual and Transgender Advocacy Committee member, Ethnic Student Center staff, Counseling Center staff, Residence Life or Prevention and Wellness staff)?
  Yes
No
You are not required to provide your name or other contact information, but the more information you can provide, the more helpful we can be.  If you include your name and contact information, you may be contacted for follow-up information and support.
 

***Important Notification about electronic submission of this form***
If you would like to send this form anonymously,
 please be advised of the following:

  • Do NOT enter your W#

  • Do NOT enter your pin

  • Do NOT enter your WWU or other email address

  • Enter as your email address xx@wwu.edu and the form will send to the EOC office anonymously.

The submitter may optionally enter their email address below. Press SUBMIT to send it.
Your Email Address: