Office of Diversity Equity and Inclusion Student Behavior and Bias Incident Reporting Form
This report documents incidents or alleged violations of harassment and/or discrimination based on age, ancestry, color, disability, gender identity or expression, genetic information, HIV/AIDS status, military status, national origin, race, ethnicity, religion, sex, gender, sexual orientation, pregnancy, protected veteran status.
This form can be utilized by Lawrence Technological University (LTU) students and LTU employees wishing to file an incident report involving a student. Reports can be filed on your own behalf or by any member of the LTU community wishing to file a report on behalf of an impacted student.
If an employee with a duty to report under the Sexual Misconduct Policy is using this form to fulfill the duty to report, including your name is optional. However, all known details about the incident, including name(s), date, location, and description is required.
A member of the Dean of Students Office or from the Office of Diversity, Equity and Inclusion will contact individuals in need of resources via email with an explanation of rights and options.
In cases of reported domestic violence or dating violence, contact will only be made to the survivor's phone number and we will not leave a message unless it is indicated that it is safe to do so.
If there is immediate risk to health or safety, please dial 911.
If you are not a member of the LTU community (student/LTU employee) please email all student related incidents to firstname.lastname@example.org