(*) Indicates a required field. The form will not be submitted if required fields are left blank
Date Occurred:* Time Occurred:* (e.g. 9:00 pm) Name of person who committed Hate/Bias incident (if known)
Location of the Incident:Nature of hate/bias incident (check all that apply):
Other (specify) Describe the hate/bias incident. Please be as specific as possible. *
Were you *: Victim Witness
Yes, I reported this hate/bias incident to: No, I have not reported this hate/bias incident to any other departments or offices at the University of New Mexico.
University status of person making report: *Student Faculty Staff Consultant/ContractorVisitor Attach any photos or other documentation (if available):
If you would be willing to be contacted confidentially by an investigator, please complete the contact information below:Submitter Full Name Phone Number Email Address