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Campus Civil Rights Survey

Page One

1. Harassment creates a hostile, offensive, oppressive, or intimidating environment and deprives its victim of his or her statutory right to be free of discrimination.

I believe that I have experienced harassment because: (Check all that apply)
2. I believe that I have experienced bullying because: (Check all that apply)
3. Hate crimes, also known as bias-motivated crimes, are criminal offenses committed against persons, property, or society motivated by prejudice or bias against an individual’s or group’s race, religion, disability, sexual orientation or national origin.

I believe that I have experienced a hate crime because: (Check all that apply)
4. “Anti-Semitism is a certain perception of Jews, which may be expressed as hatred toward Jews. Rhetorical and physical manifestations of anti-Semitism are directed toward Jewish or non-Jewish individuals and/or their property, toward Jewish community institutions and religious facilities.” - European Monitoring Center on Racism and Xenophobia

I believe that I have experienced anti-Semitism because a student, faculty or staff member: (Check all that apply)
5. Federally funded schools are required by Title VI to be free from discrimination based on race, color, or national origin. It also protects against discrimination based on actual or perceived shared ancestry or ethnic characteristics.

I believe that there may be a Title VI violation because: (Check all that apply)
6. I believe I have received different and unfair treatment by the faculty and administration because: (Check all that apply)
7. Other Potential Civil Rights Violations: (Check all that apply)
8. Please choose all that apply to you:
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Thank you for responding honestly and thoughtfully to this important survey. We welcome you to contact us at info@campuscivilrights.org.

Please remember, we will not disclose your personal information to any third party without your consent.