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Bias Incident Reporting Form

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Jim Fry, Business

Burlington Bike Share project by student Alexander Dahl

Burlington, VT, USA
Phone: 802-860-2700 or 800-570-5858
Campus Safety & Security: 802-865-6465

	Enter the exact location or address where this incident occurred:

	Enter any special dates/times when this incident occurs/has occurred:

	Explain why you suspect a bias crime/incident has or is being committed at this location (please provide as much detail as possible):

	Optional: If you are willing to talk to a campus public safety officer, please provide the necessary contact information:

	Select the type of incident occurring:

	Where did the incident occur?

	Suspect's name:

Public Safety