Campus Climate Incident Online Report Form

The University of Texas at Austin is committed to addressing incidents that impact our campus climate, especially those that are bias-related. Your assistance in bringing these incidents to our attention will enhance our ability to systematically identify and respond to such events. Please use this form to report a bias incident to the Campus Climate Response Team. If you are interested in learning more about the process, please visit the links below:

• Learn about the Campus Climate Response Team and examples of bias incidents

http://diversity.utexas.edu/ccrt/

• Learn about reporting campus climate incidents and how to report incidents by phone or in person

http://diversity.utexas.edu/ccrt/reporting/

• View frequently asked questions about reporting bias incidents

http://diversity.utexas.edu/ccrt/faqs/

Do not use this form if you are currently in a situation where immediate police, medical, psychological or other emergency services are needed. In the event of an emergency, call 911 or the University of Texas Police Department at 512-471-4441 for assistance.

Though every effort will be made to ensure the privacy of enrolled UT-Austin students, the Campus Climate Response Team cannot guarantee confidentiality in every situation. Please be aware that we have a legal obligation to respond institutionally to situations that may threaten the safety of The University of Texas at Austin community or that potentially violate the Institutional Rules on Student Services and Activities and/or university policy.

The Campus Climate Response Team is not a confidential space for reporting incidents related to sexual assault, sexual misconduct, stalking, interpersonal violence (dating and domestic) and sexual harassment, which fall under Title IX federal guidelines. To report sex discrimination, sexual harassment (including sexual violence), interpersonal violence or sexual misconduct by a student, member of the faculty or staff, or campus visitor or contractor, please contact the Institutional Title IX Coordinator.

UT-Austin students can access a confidential space through the Counseling and Mental Health Center (CMHC) and University Health Services (UHS). Voices Against Violence in CMHC offers advocacy appointments where you can talk about reporting options, safety concerns, and access support for any related financial concerns. You can also access advocacy, academic support/professor notifications, and additional financial resources through Student Emergency Services in the Office of the Dean of Students.

Providing contact information below is optional. If you choose not to provide this information, the form will be submitted anonymously. However, in many cases, a more effective response to the campus climate incident can be implemented if university staff has an opportunity to ask follow-up questions if necessary.

Additional Resources
• Institutional Title IX Coordinator: https://titleix.utexas.edu
• Counseling and Mental Health Center: http://cmhc.utexas.edu
• University Health Services: http://healthyhorns.utexas.edu
• Voices Against Violence: http://www.cmhc.utexas.edu/vav/index.html
• Student Emergency Services: http://deanofstudents.utexas.edu/emergency/























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(Be as specific as possible)


Describe all comments, conduct, gestures, markings, physical injuries, property damage, etc. Identify alleged offender(s) by name and UT Austin affiliation, if known, or by physical appearance. List any possible witness(es) by name with contact information, if known, or if unknown please indicate if there were any witnesses.


Please feel free to upload files such as photographs of the incident.




















If yes, please identify the office and person to whom you reported the incident. (Optional)


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