BIRT Report

Bias Impact Response Team Report
Emergency?
On-campus emergency number: 9-911
Non-emergency situations requiring police response: 360-459-4333
SMU Office of Public Safety: 360-438-4555 or ext. 4555

For questions or concerns, please contact the Associate Dean of Students, Ann Adams, at 360-486-8842. In the event that the Associate Dean is not available during business hours, call the Assistant Dean of Students Affairs, Justin Stern, at 360-688-2920; or call the Dean of Students, Melanie Richardson, at 360-438-4367.
Background Information

Please provide background information. This information willbe held in the strictest of confidence and will only be used for BIRT purposes. Only those areas with asterisks are required.
Name

First Name Last Name
Phone Number

Area Code Phone Number
Email
example@example.com
Position/title
Urgency of this report *

Not urgent Extremely Urgent Unsure
Date of incident *

Month Day Year
Date
Time of incident *

: Hour Minutes AM/PM Option
Location of incident *
Description of incident
Supporting documentation

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Bias Impact Response Team Report