Report Bias Form

Report Bias Form

Bias Incident Reporting Form

Complete the form below to report alleged bias incidents. You may submit reports anonymously however, being able to contact you for further information will aid in the investigative process.

Bias Incident Reporting Form

Your Name

First Name Last Name

Your Address

Street Address
Street Address Line 2
City	State
Zip Code	Country

Your Phone Number

Area Code Phone Number
If you supply an email below you will receive an email confirmation of your submission.
Your E-mail
Please describe the information you are providing, being as specific as possible (include any relevant names, dates and identifying features of people involved): *
*This form will be kept confidential, however, any information submitted can be intercepted by a third party over the Internet. If you feel uncomfortable about submitting this form online, please contact us via U.S. mail or by calling 1-800-277-2427.
Enter the message as it's shown *
Should be Empty:

Division of Criminal Justice

Report Bias Form

Bias Incident Reporting Form