Community Accountability Reporting Form

Department Contact

1600 Harden Street
Columbia, SC 29204

803-253-5000

Office Hours 9:00AM - 5:00PM

This form is intended for reporting incidents of bias or intolerance allegedly committed by Benedict College students. If you have a bias concern related to a Benedict College Faculty or Staff member, utilize the reporting form located here.

Once submitted, the information is routed directly to the Dean of Students Office for review. Information obtained through these reports will assist Benedict College in addressing and tracking incidents of bias and intolerance. If you prefer to report an incident in person, please contact the Dean of Students Office.

Incidents that are not bias-related should not be reported using this form. If you wish to report an incident that is not bias-related, please visit the Dean of Students office.

While anonymous reports are accepted, you are encouraged to provide your name and contact information in order to allow us to most effectively and efficiently address the report. We must have the name of the person you are reporting in order to follow-up and provide appropriate assistance.

Please note that if you identify yourself, you may be contacted upon receipt of your submission in order for the Dean of Students Office to gather additional information. Thank you for assisting us in keeping Benedict College safe and free of discrimination, harassment, and bias.

Background Information
Name
First Last
Phone
Email*
Address
Street Address Address Line 2 City State ZIP Code
Date Of Incident*
MM slash DD slash YYYY
Time Of Incident*

: Hours

Minutes

AM/PM
Specific Location Of Incident*
Involved Parties
List
Name or Organization Gender Role Phone Email Hall/Address
Questions
Incident Description. Please describe the incident with as much factual detail as possible. Please include information about the nature of the incident (e.g., physical assault, verbal assault, threats, written slurs, threatening communications, etc.), and please be as specific as possible. If you have any documentation (e.g., photos, emails, video, other documents, etc.), you can attach them below under Supporting Documentation.
Was this incident reported to any other campus agency or department? If yes, please indicate where in the Incident Description section above.*
- Yes
- No
- Unsure
Do you know who did this? If yes, please indicate who as the perpetrator(s) in the Involved Parties section above.*
- Yes
- No
- Unsure
Please add any additional comments, information, or observations you wish to share.*
Do you wish to be contact regarding this incident? (If you are submitting the report on behalf of another individual, do they wish to be contacted regarding this incident?)*
- Yes
- No
Supporting Documentation
Photos, video, email, and other supporting documents may be attached below.
Drop files here or

Max. file size: 1,000 MB.
Attachments require time to upload, so please be patient after submitting this form.
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Name or Organization	Gender	Role	Phone	Email	Hall/Address

Community Accountability Reporting Form

Department Contact

Background Information

Involved Parties

Questions

Supporting Documentation

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