Hate Crime/Incident Report

Hate Crime and Hate Incident Report

If your immediate safety is at risk, if you are witnessing violence, or if you perceive imminent harm to yourself or others, please call Chaffey Police at (909) 652-6911. If you are off campus, call 911 or the local police agency in the area.

Your report is confidential as allowed by law and will be sent directly to the Chaffey Police and the Chaffey Title 5 Coordinator. You have the option of submitting this report anonymously.

Possible Motivation(s)? (Required response. Check all that apply)*

Ethnicity, Ancestry, or National Origin Race Religion Sexual Orientation Gender Gender Identity Disability

Other:

Where did the incident take place? (Required response. Check all that apply)*

Rancho Cucamonga Campus Chino Campus Fontana Campus Zoom/Other Online Platform

Other:

Date and time of the incident (If you don't know the exact date & time, please provide an approximate timeframe or specify “not sure”) (Required response. Check all that apply)*

Description of the incident (Provide as much detail as possible) (Required response.)*

Please identify, if known, the person(s) who you believe may have been responsible for, orchestrated, or participated in the hate crime or hate incident that you are reporting. This could be a person’s name, Twitter handle, other social media handle, Zoom name, or any additional contact info. etc. (optional)

How did you become aware of the incident? (Required response. Check all that apply)*

I am the victim of the incident I witnessed the incident I heard about the incident from a witness I heard about the incident from a person who may have been responsible for the incident I saw the incident posted on social media or the internet

Other:

Please identify any witnesses, include the witnesses’ contact information (email and/or phone), and indicate if they are a Chaffey student or employee (optional)

Have you reported this to any of the below departments or agencies? (Required response. Check all that apply)*

No Chaffey Administration Chaffey Police Local Police or other Law Enforcement Agency

Are you a Chaffey student? (optional)

Yes No

Are you a Chaffey employee? (optional)

Yes No

Name, email, and phone of person making report (optional)

Attach photos, video, email, and other supporting documents may be attached below. 5GB maximum total size. Attachments require time to upload, so please be patient after submitting this form. (optional)

No File Chosen

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