Report of Discrimination or Bias

University of Mary Hardin-Baylor Report of Discrimination or Bias

NOTICE: If you are reporting discrimination on the basis of sex (including sexual harassment, sexual violence, dating/domestic violence or stalking), do not use this form. Please click here to use a more specific Report Form, or contact susan.owens@umhb.edu
What is your relationship to the incident?*

I am the person who experienced the discrimination or biasI witnessed discrimination or biasOther
If you experienced the discrimination or bias, how did it affect you? (check all that apply)

It affected my academic performance, academic opportunities or learning environmentIt affected my participation in a university-sponsored event or programIt affected my university employment
What do you think was the basis of or motivation for the incident? (check all that apply)

RaceColorNational OriginAgeDisabilityRetaliation
Where did the incident(s) occur? (check all that apply)

In a public space on campusIn a campus classroomIn campus housingAt a campus eventIn a university employee’s officeAt a campus recreation or athletic facilityWhile working at a campus jobDuring an off campus clinical or internship experienceOnline/Social MediaOff campus (community setting, private residence, etc.)Other
When did the incident(s) occur? Please be as specific as you can. Do you know the date? Month? Season? Year? If you are reporting multiple incidents, provide a range.
Please describe the incident as completely as possible. Include what led up to the incident and what happened. What was said? What happened after the incident? Who was responsible for the incident, including names or job titles if you know them. Were others present - students, friends, faculty, staff, etc.? (You can include their names below if you want to.)
Did incidents like this occur more than once?

YesNo
If you want to provide names and contact information for anyone who witnessed the incident(s) or may have information about it, please include that here. This information may include first and last name, and status (student, employee, etc.,) and contact information if known.
If you wish to submit supporting documentation (documents, photos, texts, emails, social media screen shots, etc.)

Browse Files

Cancelof
I am a:*

current studentformer student who left UMHB prior to graduatingUMHB alumnusUMHB employeeOtherI prefer not to respond
What would you like to see happen as a result of your report?*
Are you submitting this report for:*

Information Only: OPTIONAL - If you would like the university to contact you further, please enter your name, phone number and email addressFormal Complaint (Contact information is required below)
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Thank you for speaking up about your concerns!
Should be Empty: