Bias Incident Reporting Form
Spartanburg Methodist Colleges aims to maintain a campus community free from discrimination, harassment, and bias where all members of campus feel they are supported, respected, valued, and heard. Bias incidents are any behaviors that target individuals or groups of individuals based on their actual or perceived identities such as race, ethnicity, gender identity, sexual orientation, national origin, social background, age, religion, disability, or other protected categories.Reports received will be reviewed by the Director of Diversity, Equity, and Inclusion and Director of Title IX & Equal Opportunity. Your contact information is necessary if you would like follow-up or feedback. Otherwise, you may enter anonymous in the name field. Please note, in certain circumstances involving safety or criminal action, we may not be able to guarantee anonymity. SMC will respond promptly and equitably to all anonymous reports, but the response may be limited due to lack of information.
Name
First Name
Last Name
Your role
Student
Employee
Other
Contact Number
(555)555-5555
SMC Email Address
example@example.com
Date of Incident
*
-
Month
-
Day
Year
Date
Time of Incident
Hour Minutes
AM
PM
AM/PM Option
Location of Incident?
*
Please Select
Administration Annex
Barrett Learning Center
Bridges Arena
Bridges Residence Hall
Buchheit Administration Building
Buchheit Tennis Complex
Burgess Student Center
Camak Auditorium
Campus Safety Office
Colleen Perry Keith Fountain
Davis Mission Chapel
Ellis Hall
Gibbs Auditorium
Grant Softball Field
Hammond Residence Hall
Johnston Outdoor Atheltic Facility
Judd Residence Hall
Kingman Residence Hall
Maintenance Office
Montgomery Science Annex
Montgomery Science Building
Mooneyham Baseball Field
Moore Athletics Activities Building (Old Gym)
Nash Soccer Field
Parsons Residence Hall
Phyllis Buchheit Board Room
Sparrow Residence Hall
Student Health Center
The Ballard Center
The Cellar Coffee and Cafe
The Dining Center
The Moore Family Fitness Center
The SMC Campus Store and Bookstore
Vassey Information Technology Center
Willard Hall
Walker
Off Campus
Specific Location?
From Name
First Name
Last Name
Involved Parties
Please list names of ALL individuals (or organizations) involved and impacted, including yourself. If you do not know all information for an individual, provide as much information as you can. Example | Victim- impacted individual(s) or organization(s) Alleged- individual(s) or organization(s) committing the bias incident
Name(s) or Organization(s) of Victim
Name(s) or Organization(s) of Alleged individual(s)
Name(s) or Organization(s) of Witness(es)
Reason(s) for Report
Please provide as much detailed information as possible to better assist us in our investigation and possible corrective action(s)
Type of incident (check all that apply)
*
Bullying
Discrimination
Email, social media, or internet post
Hazing
Inappropriate comment
Intimidation
Offensive classroom content
Phone harassment
Physical attack
Property damage/graffiti
Vandalism
Verbal assault
Written slur
Other
Type of Bias (check all that apply)
*
Age
Disability
Ethnicity
Gender identity/expression
Gender/perceived gender
Nationality/immigration status
Physical appearance
Race
Religion
Sexual orientation/perceived sexual orientation
Socioeconomic status/class
Veteran status
Unknown
Other
Description/Narrative-Please describe what happened in as much detail as possible.
*
In your opinion, how could this be resolved?
Submit
Should be Empty: