Online Hate Crime and Bias Incident Reporting | Expect Respect

In an emergency, dial 9-1-1. this e-mail form will be directed to the Dean of Students' Office and/or Office of Institutional Equity when you click on the "Send Message" button below. Information reported on this form is considered confidential to the extent permitted by law and/or consistent with the University's mission. You may also call us during regular business hours at 734.615.BIAS (2427). Thank you for contacting us.

E-mail address:

Subject of Report:

Send me a copy of this report

1. Your Name:

2. Are you a:

U-M Student
U-M Faculty/Staff
U-M Temporary Staff
Other (please specify)

3. Are you a:

Victim
Witness
Other (please specify)

4. May we contact you for additional information?
Please note that our ability to account for incidents and to be responsive will be enhanced by your willingness to be contacted.

Yes
No

5. Best way to contact you:

E-mail

(provided in E-mail address above)

Phone

6. If you prefer not to be contacted, is there someone else who can be contacted for more information? Please indicate the name of the person and how to reach him/her. Please provide a short explanation of why you cannot be contacted directly and how this other person can be helpful.

Name of person to contact:

Contact Information:

Why you cannot be contacted; how this other person can be helpful

7. Information about the incident:

Type of Incident:

Where did this occur?

When did it occur?

What do you think motivated the incident? (e.g. race, sexual orientation, etc...)

8. Please describe the offender(s)'s appearance - including but not limited to - name, sex, approx height and weight, skin color, hair and eye color, facial hair descriptions, what they were wearing as far as clothing, glasses or no glasses, and other distinguishing characteristics.

9. Please tell us everything else you know or can recall about this incident and how this occurred. If you feel comfortable please include information about who was involved. Please provide as much information as you can.

10. Please list any additional witnesses (and how we might contact them).