Bias Incident Form

Bias Incident Form

The purpose of this form is to collect bias incidents impacting DIS students.

Please provide your contact information below so we can identify how to best support you. DIS staff will follow up within three business days.

While you may choose to submit an anonymous report, this will limit our ability to assess, take action, and provide support to anyone involved. For more information about the DIS bias process, please visit the bias incident webpage.

Note: This form is not intended for emergencies or to receive immediate support. If your immediate safety is being threatened and/or you would like to report a crime, please report crimes to the Danish Police or the Swedish Police.

In addition, we encourage you to reach out to the Care Team and DIS if you would like additional assistance from our suppot resources:

Copenhagen Emergency Phone: (+45) 3067 1000

Copenhagen Care Team: book an appointment in the DIS Navigate App or email care@dis.dk

Copenhagen Academic Support: book an appointment in the DIS Navigate App or email acadsupp@dis.dk

Stockholm Emergency Phone: (+46) 72 1412862

Stockholm Care Team: book an appointment in the DIS Navigate App or email care@dis.dk care@disstockholm.se

Stockholm Academics: book an appointment in the DIS Navigate App or email academics@disstockholm.se

1. Full Name (optional, but highly encouraged). Please be aware that if you choose to leave this field blank, this will significantly limit our ability to fully assess the incident and support you

First NameLast Name

2. Email (if you want to receive a receipt for your submission; otherwise screenshot the completed form before submission)

example@example.com

3. If needed, what is your preferred method for follow-up?*

Do not contact meEmailIn personPhone

If you select the "phone" option, please add your number in the textbox below

4. Date of incident (if known)

Date

5. Location of Incident(s) (if known)

6. Please select all that apply in describing the type of incident(s)*

Physical (i.e., grabbing, pushing, pulling)Behavioral (i.e., bullying, harassment)Verbal or Visual (i.e., offensive comment or representation)Other

7. Please select all that apply in describing the type of bias*

8. Please provide a narrative description of the incident(s). Describe what happened in as much detail as possible.*

9. If appropriate or relevant, provide any details or descriptions of individuals that were involved in this incident(s). This may include witnesses or people directly involved in the incident(s).

10. Do you have any questions or additional information that might be relevant?

11. What do you hope would happen next? *

For Security and IT purposes, please verify*