Bias Incident Report Form

At Pacific Northwest University of Health Sciences (PNWU), we respect the dignity of every individual. We expect members of the PNWU community to conduct themselves in a manner compatible with the University's mission and vision as an educational health sciences institution. The Bias Incident Response Team (BIRT) supports community members by providing access to resources and reporting options.

We are committed to providing a learning and working environment that is free from discrimination, harassment, and bias on the basis of a personal identity for all community members: students, faculty, and professional staff. Please review the definitions of discrimination and harassment and of personal identity in PNWU's Discrimination, Harassment, and Sexual Violence policy at https://www.pnwu.edu/about/policy-library/equal-opportunity-non-discrimination-and-harassment-policy/

We encourage community members to seek assistance for incidents involving discrimination, harassment, or bias on the basis of a personal identity by completing this form, which will go to the Bias Incident Response Team (BIRT). For incidents involving sexual violence, contact the Title IX Coordinator. If you further questions regarding the Bias Insident Reporting and Responding, please email BIRT@PNWU.edu

This form is for non-emergency incidents only. For emergencies, including safety concerns for members of the PNWU community, contact the local police at 911 or the PNWU Campus Security office at 509.823.3346 or 509.249.7727.

Submitting an incident report form does not automatically trigger a formal action. Reporting simply means letting BIRT know about something that has occurred.

* Required

1. Date of the incident*

2. Time of incident*

3. Where the incident occurred*

On campusOff campusVirtual meeting/class setting (Zoom, Teams, etc.)

4. Your connection to the incident*

Impacted PersonWitnessSupport PersonOther

If you answered "other" for number 4, please write your connection to the incident

5. Description of the incident *

Please note that if you submit an anonymous report, BIRT will not be able to contact you. If you would like a response to your report, please include your name, cell phone number, and email address. Reports submitted anonymously limit BIRT’s ability to address your concern(s).

6. Your name

First NameLast Name

7. Your cell phone number

Though not required, including your cell phone number will allow CIRT to follow up with you.

8. Your email address

Though not required, including your email address will allow CIRT to follow up with you.

9. Your PNWU affiliation

If you answered "other" for number 9, please write your PNWU affiliation

10. Would you like a member of BIRT to contact you to discuss your report?*

Yes (Please note, to receive a response from BIRT, you must provide your name and cell phone number or email address above.)No, I am submitting the report for informational purposes only.