UMass Amherst Stonewall Center

The Stonewall Center at UMass Amherst
Photo - inside the Stonewall Center

Anti-LGBTQIA Incident Report Form

Please do not use this form if you are currently in a situation where immediate police, medical, psychological, or other emergency services are needed. In case of an emergency, call 911 to obtain the appropriate services.

The information you provide will be kept confidential, unless you indicate otherwise. You need not provide your name, phone number, or email if you want to report the incident anonymously.


* Fields marked with an * are required.

( ) -
   

Victim
Observer
Heard about it




(Please check all that apply.)
Resident Assistant (RA)
Residence Director (RD)
Dean of Students
Campus Police
Ombuds Office


Yes No

Yes, and you may include my name and contact information.
Yes, but please do not share my name and contact information.
No, please do not share any information with others.

Yes (if yes, please be sure to include your email or phone number)
No