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Incident Report Form

This form will provide students with a platform to report any discriminatory incidents, including but not limited to: race, gender, age, disabilities, sexual orientation, and/or religion etc. If you have any questions or concerns with the form, located on the NBLSA website, please reach out to Jeryne Fish at

Upload Any Documents/Evidence (OPTIONAL)

Thank you for reporting this incident. We will get back to you as soon as possible.

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