Boston College Hate Crime and Bias-Motivated Offensive Conduct Incident Recording Form



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Boston College Hate Crime and Bias-Motivated Offensive Conduct

Incident Recording Form
The information collected on this form will help track the frequency and nature of hate crimes and bias-motivated offensive conduct in the Boston College community. We encourage you to report incidents of hate to the Boston College Police or other designated authorities before using this form. See either the “If you have been a target of hate” or the “If you have been a witness” section of the Hate Crime and Bias-Motivated Offensive Conduct Protocol for further information about what should be reported and how to do so.
Now that you have accessed the form you may use it immediately or save it and fill it out at your convenience. Please fill out as many sections of the form as you can. Once the form is completed and saved, send it as an e-mail attachment using your BC email account to Richard Jefferson, Executive Director of the Office for Institutional Diversity at richard.jefferson@bc.edu . You may also print your completed form and hand deliver it to Mr. Jefferson at the Office for Institutional Diversity, 129 Lake Street, Room 211. Forms received via Campus Mail or U.S. Mail will not be accepted.
The Office for Institutional Diversity will hold your identity in confidence in this process unless it determines that a felony may have been committed. If you have any questions about the form, its use, or the Hate Crimes and Bias Motivated Conduct Protocol, please contact the Office for Institutional Diversity at 617-552-2323 or visit the Hate Crime and Bias-Motivated Offensive Conduct web home.

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Click in a Grey area to begin entering a response


     

1. Name of person providing this information (optional):




2. Status of person reporting:

     

If other please specify:



     

     
3. Date this report was made:


Month Date Year



     

     

4. Date incident occurred:


Month Date Year


     

5. Approximately what time did incident take place  A.M.  P.M.

(Midnight = 12: a.m.; noon = 12:00 p.m.)


6. This is a:

 New report

 Modification of an existing report
7. Is the person filling out this form:

 The target/victim of this incident

 A witness to this incident

 A friend or acquaintance of the victim who did not witness the incident


     
 A friend or acquaintance of the perpetrator who did not witness the incident

 Other (Please specify):

8. How many people were attacked or targeted in the incident?
Were they (check all that apply):


 BC student(s)

 BC staff

 BC faculty

 Family member of BC student/staff/faculty

 Not affiliated with BC

 General BC community


     
 Other (Please specify):

 Don't know




     

9. How many perpetrators were involved in the incident?


Were they (check all that apply):

 BC student(s)

 BC staff

 BC faculty

 Family member of BC student/staff/faculty


     
 Not affiliated with BC

 Other (Please specify):

 Don't know

10. In the space below, please describe the perpetrator(s) in as much detail as possible, including name, gender, estimated age, and physical characteristics etc.


     

11. Where did the incident take place?




 Residence Hall

 Classroom

 On-Campus

 Off-Campus

 Shuttle Bus

 Office/workplace

 Administrative or academic building


     


 Other (Please specify):

     
12. Please identify/describe the location in the space below. Be as specific as you can.

(e.g. More Hall 3rd floor)
13. In the space below, please describe what happened in as much detail as you can, including times, locations, number of witnesses, and the details that make you believe the incident was hate-motivated.


     


14. What types of identity do you believe this incident was targeting (i.e., was it based on assumptions about race, sexual orientation, disability, etc.)? Please check all that apply.



 Race

 National origin

 Ethnicity

 Immigration Status

 Gender/transgender identity

 Sexual orientation

 Social/Economic class

 Religion

 Disability


     


 Other (Please specify):

15. What form(s) did the incident take? Please check all that apply.


Written/ Verbal:

 Verbal

 Mail


 E-mail

 Telephone call

 Graffiti


     


 Other (Please specify):

Vandalism:



 In or near living space

 Vehicle

 Work space

 Personal property

 Administrative or academic building


     


 Other (Please specify):

Physical assault:


     


 Without a weapon

 With a weapon (Please describe):

 Sexual assault


     


 Other (Please specify):
16. Was this incident reported to anyone?  Yes  No


     

If yes, to whom was it reported?

     
Were you satisfied with the result? Explain.

17. Would you like a trained advocate to contact you to follow up on this report?  Yes  No



     
If you answered yes to the last question, please write in the space below any contact information you would like us to have (name, telephone number, e-mail address, etc.) You do not have to enter this information to file a report.

Thank you for completing this form. If you wish to make changes or additions to your report at any time, please use this form again and check “Modification of an existing report” in question 6.





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