Bryant University Bias Incident Report
Complete and print this form and return it to the Public Safety Office on the basement level of the Unistructure. If you need more room, please print and complete more sheets and attach them together.

Your Name:
Phone Number:
Today's Date:
Incident Information ---------------------------------------------------------------------------------------------------------
Date of Incident:
Time of Incident:
Location:
Person(s) Involved -----------------------------------------------------------------------------------------------------------
Name Campus/Local Address Phone Number
Describe the Incident (state specific details and facts) ------------------------------------------------------
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For staff use only:
Public Safety called: Residence Life called:
Counseling Services called: Student Affairs called:
Academic Affairs called:    
Other referrals:
Staff Signature:
Date: