Charlie Glickman Accountability Form
INTRODUCTION
This form is part of the external accountability system of Charlie Glickman, a somatic sexuality & relationship coach and sexuality educator living and working in Seattle. Its purpose is to help Charlie avoid harm and keep him accountable to his clients, colleagues, and communities.

We are focused on issues that have not been addressed in Charlie's past. See here for details of Charlie's previous accountability process, which finished in early 2023. We were not a part of that process and can't speak to it.


WHO WE ARE 
We are Charlie’s external accountability team. We are professional coaches and educators whom Charlie has hired for this role.
- Alyssa Morin (https://alyssamorin.org/)
- Mischa Byruck (https://www.evolve.men/)

This form draws heavily from material Charlie's previous accountability team drafted. It goes directly to us and no one else.

OUR COMMITMENT TO YOU
- We will hear you with respect and compassion
- We will never share your name or any identifying information with anyone (INCLUDING CHARLIE) without your expressed and affirmative consent
- We will do our best to protect you from any negative consequence of sharing with us

PLEASE USE THIS FORM IF:
- you wish to provide feedback to Charlie
- you've experienced or know of any harm Charlie’s caused

You can share both specific incidents or larger behavioral patterns. This form is always open.

WHAT HAPPENS NEXT
When you click submit, here’s what will happen:
- We will receive an email directly from the form. We won't let Charlie know.
- We will reach out to you to confirm receipt
- We MAY but won't necessarily, follow up with you, and only if you are open to it

Based on what we receive, we are empowered to take the following actions, without Charlie’s permission:
- Instruct Charlie to suspend or stop teaching, coaching, and/or writing
- Instruct Charlie to make modifications to his current accountability systems
- Communicate with anyone we need to about Charlie
- Write social media posts or newsletters that Charlie will publish verbatim
- Share anonymized feedback on behavioral patterns we observe with Charlie to effect behavior change
- Share any concerns with Charlie's professional organizations (The Association of Certified Sexological Bodyworkers and the Somatica Institute) while honoring our commitments to confidentiality

If you have questions about this form or our process, or just want to share with us directly, please email the team directly at cg-accountability-team@googlegroups.com.
Sign in to Google to save your progress. Learn more
What name(s) would you like to go by? (You are welcome to write "anonymous" instead of providing a name.) If providing names, please specify if these are legal names, pseudonyms, initials, etc.
Do you have any identities you'd like to note here, especially (but not solely) if you feel they impacted how you experienced your interactions with Charlie? 
What is your relationship with Charlie?
Please note especially any formal or informal power dynamics that exist or have existed between you and Charlie
Please share your experience in as much or little detail as you prefer. We encourage you to give context so we get a full understanding.
If you did not include it in your experience, please tell us the date or timeframe when the incident(s) happened.
Has this issue or incident already been addressed in some way, and if so can you provide some details about how?
What response, if any, would you like to see as a result of sharing your experience? (We cannot guarantee any outcome or result, but we'd like to know) 
If you’re open to being contacted by us for clarification or follow-up, please let us know how to get in touch with you:
It's really helpful to us to be able to contact you. We will hear you with respect and maintain your anonymity as requested.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Mischa Byruck Consulting.

Does this form look suspicious? Report