Stop Hate Reporting Form

If this is an emergency, please call 911 immediately.

This Reporting Form is designed to gather information about hate crimes and hate-motivated incidents at UC Berkeley, to connect victims and witnesses to any requested resources, and to take institutional action if they so request. If we receive information requesting no further action, please be aware that we do have a legal obligation to respond institutionally to situations that may threaten the safety of the individual who is requesting information, or the safety of others.

* denotes required questions

Information About the Incident

1. Please tell us the date and approximate time of the incident:

2. Location (provide an address or cross streets if possible):

3. Please describe the incident in as much detail as possible: *

4. What do you believe was the hate-motivating factor in this incident? (e.g. racism, homophobia, etc) Why do you believe this?: *

5. If you reported this incident to another agency, please let us know the agency and the professional/staff person you spoke with, if known (eg. UC Police Department, City of Berkeley Police Department, Tang Center, etc):

Information About the Offender

Please provide as much information about the primary offender as possible. If there were multiple offenders, please provide that information in the "Additional Information" field below.

6. Name of Offender:

7. As best you can, please describe what you believe to be the primary offender's age, race, gender, etc.:

8. Please provide any additional pertinent information, including descriptions of additional offenders:

Information About the Victim

Please provide as much information about the primary victim as possible. Please provide information about additional victims in the text box of question #12.

9. I am...:

10. Name of Primary Victim:

11. As best you can, please describe what you believe to be the primary victim's age, race, gender, sexual orientation, religion, ethnicity, etc.:

12. Please provide any additional pertinent information, including descriptions of additional victims:

Information About You

Please fill out this section with information about yourself if you are the victim, or a bystander, witness or friend.

13. Name:

14. Age:

15. Gender:

16. Race:

17. Sexual Orientation:

18. Religion:

19. Ethnicity:

20. How do you know about this incident?: *

21. I am a UC Berkeley: *

If you selected "Other" in question #21, please indicate your relationship to the campus in the text box of question #22.

22. Any additional pertinent information?:

23. I would like to be contacted by a staff person:

Yes

24. If you answered yes to Question #23, please provide contact information:

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Math Question: * 1 + 0 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

Stop Hate Reporting Form

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