Bias Incident Report Form

This form is to be used if you believe you have experienced or witnessed discrimination between a student complainant (alleged victim) and a student respondent (alleged perpetrator).

The College of Saint Benedict (“CSB”) and Saint John’s University (“SJU”) (collectively the “Institutions”) are committed to working toward a workplace and educational environment, as well as other benefits, programs, and activities, which are free from discrimination, harassment, and retaliation. Discrimination, harassment, and retaliation of any form are a violation of a person’s rights, dignity, and integrity. Such acts debase the integrity of the educational process and work environment and are contrary to the mission and values of CSB and SJU. This Policy outlines the Institutions’ expectations to promote a campus free from discrimination, harassment, and retaliation, the steps for recourse for those individuals who have been subject to such conduct, and the procedures for determining whether a violation of CSB or SJU policy has occurred.

Incidents of bias, harassment, and hate crimes all include some form of unwelcome conduct that is based on a person’s race, color, creed, religion, national origin, sex, sexual orientation, gender identity or expression, disability, age, marital status, family status, status with regard to public assistance, or any other protected characteristics.

Please use the form below to report any behaviors of concern involving CSB/SJU students, faculty or staff whether these behaviors occur on or off campus. Please note that if you choose to report anonymously, CSB/SJU’s ability to respond may be limited.

If you need to report an immediate emergency, call CSB Campus Security 363.5000 or SJU Life Safety at 363.2144 or dial 911. This form is NOT a policy report. If you are a victim or are aware of criminal conduct, you are encouraged to contact local law enforcement. CSB Campus Security and/or SJU Life Safety can assist you in making such a report.

Please note, if you make an anonymous report using this form, CSB/SJU will not be able to respond directly to you but will assess the information submitted and consider response options.

Your first and last name

Your affiliation to CSB|SJU

Your phone number (with area code)

Your email address

Your status to incident

	I experienced the bias directly
	I witnessed the incident
	I heard about the incident and wanted to report it
	I heard about the incident, and I am helping the target/bystander complete this form

Date and time of incident

Please provide a detailed location of incident

Nature of Incident

(check all that apply)

	Written/drawn: Posters; Vandalism: Graffiti
	Physical intimidation/assault; Threat of harm; Intimidation; Physical injury
	Derogatory jokes or comments based on a social identity (race, religion, sex, ability, religion, etc.)
	Notes, letters, or written message
	Electronic communication and/or social media posts or email
	Verbal comment
	Retaliation
	Other (please explain)

Please provide a detailed description of the incident (including relevant information about what happened immediately before and after the incident).

Please upload any media (photo, video, audio, etc.) if you have it. (Optional)

(Maximum upload size of 25MB)

Please describe or identify the person(s) you believe to be responsible for this incident:

Please also note the person's relationship to CSB|SJU (student, staff, faculty)

	Person 1
	Person 2
	Person 3
	Person 4
	Person 5

	Student
	Staff
	Faculty
	Alumnae/i
	Community Member

	Race
	Religion
	Color
	National Origin
	Sex
	Sexual Orientation
	Age
	Marital Status
	Disability
	Familial Status
	Status with regard to Public Assistance
	Other legally protected category (please describe)