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 other pages linked on the left side of this page:
• Learn about the Campus Climate Response Team and examples of bias incidents
• Learn about reporting campus climate incidents and how to report incidents by phone or in person
• View frequently asked questions about reporting bias incidents
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.
All reports will be kept confidential to the extent possible. Please be aware that we do 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 university policy.
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.
* Represents a required field
What is your association with the incident?
What is your affiliation with The University of Texas at Austin?
Date of Incident
Approximate time of Incident
Did the incident occur on campus?
Location(s) of Incident
(Be as specific as possible)
Provide the facts of the incident in as much detail 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 the incident is bias-related, what is the perceived motive for the bias? Please select all that apply
Unsure / Do Not Know
Other (Please Specify)
Have you reported the incident to another University of Texas at Austin office?
If yes, please identify the office and person to whom you reported the incident. (Optional)
What response did you receive from the office to which you initially reported the incident?
What type of response would you like to see as a result of reporting this incident?
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