Peers Responding to Bias
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Your Name * 
Email address
Phone Number
Subject of Report
Are you a
Are you a:
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.)
Best way to contact you
Type of Incident
Where did this occur?
When did this occur?
What do you think motivated the incident?
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 distin
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.
Please list any additional witnesses (and how we might contact them). Please limit to no more than 500 characters.