Bias Incident Reporting Form

Background Information

Your full name:

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Or, you may write Anonymous

Your affiliation with IMSA:

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student, parent, staff, visitor, alumni, vendor, etc.

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please fill in as much known information as you can provide about all of the individuals involved, (including yourself).

For the "Involved Parties" section of the report, the following definitions are applicable on this form:

Alleged- a person who is suspected of a violation of IMSA's Student Parent Handbook
Victim- an individual who has been harmed or injured as a result of an action or event
Witness- an individual who directly saw an event or has knowledge of an event from personal observation or experience

Name

Select Gender

Select Role

ID Number (if known)

Hall/Address (if known)

Questions

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Background Information

Involved Parties

Questions

Supporting Documentation

Submission