DSA San Diego Official Harassment Grievance Form

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Completion of this form helps ensure thorough investigation + resolution of harassment grievances within our chapter.

Name: *

Email Address: *

Phone #: *

What is the best way to contact you? *

Phone

No Preference

Other:

Please tell us why you are filing a grievance: *

When did the problem initially occur? If it's been an ongoing issue, you can enter multiple dates: *

Have you engaged in dialogue with the person(s) against whom you are filing this grievance prior to filling out this form? *

Yes

Please let us know of any other individuals who may be involved or have additional information that we should take into account: *

Are you open to mediation with the person(s) against whom you are filing this grievance? *

Yes

Maybe

If you answered "maybe" to the above question, please explain your concerns here:

What is your desired outcome? *

Is there anything else we should know?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report