Policy Text
HATE CRIME CHECKLIST
Page
of
Victim Type:
Individual
Legal name (Last, First):
Other Names used (AKA):
School, business or organization
Name:
Type:
(e.g., non-profit, private, public school)
Address:
Faith-based organization
Name:
Faith:
Address:
Target of Crime (Check all that apply):
Person
Private property
Public property
Other
Nature of Crime (Check all that apply):
Bodily injury
Threat of violence
Property damage
Other crime:
Property damage - estimated value
Type of Bias
(Check all characteristics that apply):
Disability
Gender
Gender identity/expression
Sexual orientation
Race
Ethnicity
Nationality
Religion
Significant day of offense
(e.g., 9/11, holy days)
Other:
Specify disability (be specific):
Actual or Perceived Bias – Victim’s Statement:
Actual bias [Victim actually has the indicated characteristic(s)].
Perceived bias [Suspect believed victim had the indicated characteristic(s)].
If perceived, explain t