Report Racism
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Email address
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Your email
Name | Alias
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Your answer
Are you reporting on behalf of yourself or another?
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Myself
Another
Where did it happen? *Name of organization/event/and or city
Your answer
When did it happen?
MM
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DD
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YYYY
What happened?
Your answer
What do you think should be done in response to this event to prevent it from happening again?
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Have you shared this experience with the organization?
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Yes
No
Was there any retaliation taken towards you for sharing your experience?
Yes
No
Maybe
Other:
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Can you list the retaliatory responses you received?
Your answer
How is your mental & physical wellbeing as a result of your experience with racism? Do you need support? What kind of support do you require? * Allyship, Infinity spaces, training, introduction to therapist and or self care facilitators, etc.
Your answer
Select all that correspond to this event:
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Theatre
Individual
Non-profit
Corporation
Violent
Microaggression
Pay and Benefits
Working Conditions
Retaliation
Online
Freelance
Contractor
Other:
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