Bias Incident Submission Form

Bias Incident Report Form

This form is used for members of ACPA - College Student Educators International to report about any bias situation or event. A bias incident is an act or behavior motivated by the offender’s bias against facets of another’s identity. Bias occurs whether the act is intentional or unintentional. Bias may be directed toward an individual or group. Bias may contribute to creating an unsafe/unwelcoming environment.

If you have an issue, comment, or complaint not related to bias, please do not use this form. Submissions can be sent to info@acpa.nche.edu or call (202) 780-9243.

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A bias incident is an act of discrimination, harassment, intimidation, violence or criminal offense committed against any person, group or property that appears to be intentional and motivated by prejudice or bias. Such are usually associated with negative feelings and beliefs with respect to others' race, ethnicity, national origin, religion, gender, gender identity, sexual orientation, age, social class, political affiliation, disability, veteran status, club affiliation or organizational membership. Please note that all identities are not legally protected identities in the United States but are affirmed through ACPA’s Core Values of diversity, multicultural competence, and human dignity.

Our intent is to use the Restorative Justice principles to resolve situations and conflicts that may be having an unintended negative impact across group membership. Our hope is also that all involved parties will engage in meaningful dialogue as we identify lessons learned.

Your responses can be anonymous unless you choose to include identifying information on this form or want someone to follow-up with you. If you choose to submit a report anonymously, we will not be able to engage you in the resolution process. You may choose to opt out of any resolution process at any point.

Thank you for your commitment to the ACPA community.

Incident Details. Please describe the details of the incident, key people involved, nature of the incident, nature of the alleged bias, and any additional information you deem to be helpful.

Date and Time of Incident

MonthDay Year Hour Minutes AM/PM Option

Location of Incident

Supporting Documentation: Photos, video, email, and other supporting documents may be attached below.

Browse Files

Feel free to add any additional details concerning the situation that you believe would be helpful as we consider ways to respond.

Would you like someone from the ACPA International Office or the Director of Equity and Inclusion to follow-up with you?

YesNo, I want to remain anonymous.

Full Name

E-mail

Phone

Would you like to receive an email copy of this Bias Incident Report Form Submission?

YesNo

If you would like more support, feel free to call the Equity and Inclusion line, (202) 780-9243, or email acpadirectorei@acpa.nche.edu.

Thank you.