Report Racism
Email address *
Name | Alias *
Are you reporting on behalf of yourself or another? *
Where did it happen? *Name of organization/event/and or city
When did it happen?
MM
/
DD
/
YYYY
What happened?
What do you think should done in response to this event to prevent it from happening again?
Have you shared this experience with the organization? *
Was there any retaliation taken towards you for sharing your experience?
Can you list the retaliatory responses you received?
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.
Select all that correspond to this event: *
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