Student Event Discrimination/Harassment Concern Report
New York FFA has a no tolerance approach to discrimination and harassment as we pursue experiences and environments that are supportive, welcoming, inclusive and growth-focused.  If you have experienced an act of discrimination or harassment, this form will bring the incident to the attention of State Leadership.

During major events, this form will be monitored at least daily by an on-site member of the State team.  At other times of year, this form will generate an email notification to staff that will be monitored during regular business hours.  Should you need more immediate attention, please reach out to an on-site staff member at any event or call 607-254-2880 after completing this form for our records.

Thank you for your willingness to report your experience or concern.  Any specific information you can provide can help state leadership provide the most appropriate and direct response.  
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Name *
Role *
School or organization you are affiliated with: *
At what event or in which program did this experience occur? *
Please describe the incident: *
If known, please share the name and chapter of the person/people who caused/participated in the harassment.
If known, please describe the role of the person/people who participated in the harassment.
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If unknown, what can you share about anyone involved in the incident?
Is there any other information you would like to share as part of this submission?
Contact information to help us best follow up with you (email, cell phone or both) *
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