UCR Form




This form provides you with information and the steps to take for hate/bias-motivated incidents and hate crimes.
As defined, a hate/bias-motivated incident constitutes an expression of hostility against the person or property of
another because of the victim’s perceived race, religion, disability, gender, ethnicity, or sexual orientation (and
does not meet the necessary elements to prove a crime). A hate crime is an act or an attempted act by any person
against the person or property of another individual or group which in any way constitutes an expression of hostility
toward the victim because of his or her perceived race, religion, disability, gender, ethnicity, or sexual orientation
according to specific California state penal codes.

Whether you believe you have witnessed or been a target of a hate/bias incident or a hate crime on campus, you
may bring the alleged incident to the attention of the Assistant Dean of Students Alfredo Figueroa (381 HUB,   
(951) 827-7215, alfredo.figueroa@ucr.edu) directly or by completing this online form and submitting it online.

The Assistant Dean of Students is available to assist you with any questions you may have about your options,
the response process, and further referral sources providing assistance. While you are not obligated to use your

name, the range of response options available to you and the UCR community is considerably greater if you do
so. All information submitted is confidential as lawful.

More information is available at www.stophate.ucr.edu or via printed brochures through the Dean of Students office
and other campus locations.



I am reporting as a:


I am currently a UCR:


Action you are requesting:

Please mark all that apply

Date of Incident:


Time of Incident:


Please specify am/pm

Location of Incident:


Please include if on or off campus

Why do you believe that you (or another involved party, if you

are reporting as a witness) were targeted during this incident?


Has this incident been reported to any other campus office?


If so, who?

Has this incident been reported to any police agency?


If so, who?

Description of Incident:


Please describe the incident as specifically and factually as possible, in chronological order.  Be sure to include all dates, times, and locations as well as a list of any possible witnesses. If you do not know the identity of the person(s) who initiated the incident, please provide as accurate a physical description as you can. Please send copies (save the original for now) of any supporting statements or materials (photos, copies of a letter, print-out of e-mail, etc.) related to the incident to 381 HUB.

Name:


Optional

Phone:


Optional

E-mail:


Optional

Last four digits of student ID number:


Optional

I prefer to be contacted (if applicable) via:


Optional
 


More Information

General Campus Information

University of California, Riverside
900 University Ave.
Riverside, CA 92521
Tel: (951) 827-1012

Career OpportunitiesUCR Libraries
Campus StatusDirections to UCR

Department Information

Dean of Students, 381 HUB
Campus Map

Tel: (951) 827-6095
Fax: (951) 827-4701

 


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