Wilfrid Laurier University Leaf
February 8, 2012
 
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Alternative Reporting Procedure



Use this hate crime/incident form to report any incident: eg.derogatory notes, graffiti, verbal or physical harassment, threats, defacement or tearing down of posters, including Positive Space materials. The information provided will be compiled and used to bring about improvements to the campus environment. Please provide as much information and detail as possible.

This form can be submitted anonymously. Contact information (at the bottom of this form) is optional and will allow us to follow-up with you on specifics of the incident or strategies to prevent it from happening again.

Incident Information
Were you a victim, observer or a third party to the incident?
Victim
Observer
Third Party
Date of Incident:
Time of Incident:
On which campus did the incident occur? (check all that apply)
Brantford
Kitchener
Waterloo (Laurier)
University of Waterloo
Where, specifically, did the incident occur?
Have you reported this incident anywhere else?
   Yes         No
If yes, to whom?
What happened? (please be as specific as possible)
Type of crime
Crime against person
Crime against property
Your Name (optional)
Your Email Address (optional)
Your Phone Number (optional)
 

Please note: We are extremely sensitive to your need for privacy. Information gathered here will be kept confidential. You have the option to self-identify or remain anonymous. No one will contact you unless you specifically request it.