You have chosen to report an incident and request support.

This means that this report will remain confidential and we will only use the information you have supplied to us to put you in contact with an advisor from the Student Wellbeing team or Human Resources for staff. This does not initiate a formal complaints process however you may be contacted to establish whether you would like us to initiate this process on your behalf using the information you provide.

We will not disclose any personal or identifiable information to others unless we believe there is a genuine threat to a person’s health and safety.

By submitting this form, you agree to the use of your personal information as detailed in our Privacy Policy.  If you would prefer not to provide this information using this method you can fill in the anonymous form. You may find it helpful to have a look at the support pages for the issue you are reporting on.

NOTE: The UCLan Students' Union Advice and Representation Centre is a designated third party Hate Crime reporting centre. All reports of Hate Crime will be anonymised before being shared with the Students' Union Advice and Representation Centre so that the incidents can be included in their monitoring and reporting.

Are you reporting on behalf of yourself or somebody else?

What is your connection with the university?

Which of the following best describes the situation your report relates to?

Offensive, intimidating, malicious or insulting behaviour involving the misuse of power that can make a person feel vulnerable, upset, humiliated, undermined or threatened.

Unwanted physical, verbal or non-verbal conduct which may intentionally or unintentionally violate a person’s dignity or create an intimidating, hostile, degrading, humiliating or offensive environment which interferes with an individual’s learning, working or social environment.

Sexual harassment is when someone behaves in a way which makes you feel distressed, intimidated or offended and the behaviour is of a sexual nature. Sexual harassment can include: sexual comments or jokes, physical behaviour, including unwelcome sexual advances and touching.

Sexual assault is any type of sexual activity or contact that you do not consent to. Sexual assault can happen through physical force or threats of force or if the attacker gave the victim drugs or alcohol as part of the assault. Sexual assault includes rape and sexual coercion.

Domestic abuse can be any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members. Including so-called ‘honour’-based abuse and forced marriage.

Unlawful discrimination takes place when an individual or a group of people is treated less favourably than others based on one of the nine protected characteristics in the Equality Act (2010). These are age, disability, gender, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief (including lack of belief), and sexual orientation.

A hate crime or incident is a criminal offence targeted at a person because of hostility or prejudice towards a person’s actual or perceived;

  • Disability
  • Race or ethnicity
  • Religion or belief
  • Sexual orientation
  • Transgender identity

This can be committed against a person or property. The victim does not have to define into any of these groups but the perception that they do must exist for it to be a hate crime with an element of hostility or prejudice.

Don't forget that the UCLan Students' Union Advice and Representation Centre is a third party hate crime reporting centre. We will make them aware when a Hate Crime is reported and you may wish to access support through them.

Tick this option if you're unsure which category the incident falls under.

Where did the incident take place?

Please provide any details of the report you would like to make

This is optional but recommended. Provide dates, names, times and locations if possible.

What do you think was the reason for the incident?

If you believe there was more than one reason, please choose what you believe to be the main reason and detail other elements in the text box on the previous page.

The Equality Act 2010 describes a disability as:

"…a physical, sensory or mental impairment, which has a substantial and long term adverse effect on their ability to carry out normal day-to-day activities."

What is I am/they are trans*?

Trans* refers to all of the identities within the gender identity spectrum.

A carer is defined as “anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support“. A carer is not a parent, unless they are caring for a disabled child.

Which area of the University are you connected to?

Please click on 'Prefer not to say' if you do not wish to provide this information.

The following questions are optional. We monitor reports by these equality groups to inform our future work. For example, we might want to know how many female students have made a report in the last 6 months. We do not include any personal details in these monitoring reports.



The Equality Act 2010 describes a disabled person as:

"…anyone who has a physical, sensory or mental impairment, which has a substantial and long term adverse effect on their ability to carry out normal day-to-day activities."

Do you consider yourself to be disabled within the definition of the Equality Act 2010?

I describe my ethnicity as…

I describe my gender as…

Is your gender identity different from the gender you were assigned at birth?

I describe my religion or belief as…

I describe my sexual orientation as…

By submitting this form you agree to the use of your personal information. If you have any questions about the form, please contact the Student Wellbeing Service's Counselling, Mental Health and Wellbeing team on 01772 893020.


Telephone number

Email address

Staff or Student Number(Optional)

Do we have permission to leave a voicemail?