OFFICE OF EQUAL OPPORTUNITY

Bias / Discrimination / Harassment Reporting Form

You may use this form to report incidents of possible discrimination or harassment such as graffiti or anonymous phone calls. If you want to discuss the situation or request assistance, please call 218-726-6849 or 6827 to set up an appointment with the director of the Office of Equal Opportunity. If the incident involves assault, damage to University property, or other potentially criminal conduct, contact the University of Minnesota Duluth Police Department directly (non-emergency: 218-726-7000; emergency: 911). Contact the Office of Risk Management and Insurance (612-625-0062), as well, if the incident involves damage to University property. The Equal Opportunity office may forward this report to the University of Minnesota Duluth Police if the incident appears to be a crime.

To report an incident, please provide information in the boxes below and click SUBMIT.

REPORT

Date of Incident:

Location of Incident:

Description of incident (include information about any people known or suspected of being involved and their role):

Basis of Discrimination (check any that apply):

Race/Color
Age
Veteran Status
Sexual Orientation/Gender Identity
Disability
Marital Status
Religion
Creed
Gender
Public Assistance Status
National Origin
Unknown
Other

*Name of Reporting Individual or Office:

*Campus Address:

*Phone Number:

*Email Address:

*You are not required to provide your name or other contact information, but the more information you can provide, the more helpful we can be. If you include your name and contact information, you will be contacted for follow-up information and support.

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