PolyDallas Millennium Incident Reporting Form
This is the place to report any incidents of inappropriate behavior you experienced at a PolyDallas Millennium event. No incident is too big or too small.
This form is a part of the process that PolyDallas Millennium has developed to maintain an open and safe line of communication.
To the best of our ability, we would like to eliminate the barriers that may deter a person from making a report.
This form is a method of maintaining the integrity of the details of incidents to decrease the likelihood of misrepresentation and mis-attribution of an incident. We must caveat that submitting this document DOES NOT substitute for any legal process that necessitates law enforcement intervention.
We are not a forensic, law enforcement, legal, or legal aid organization. We have no affiliation with any legal entity. Additionally, if we believe the information that is reported is outside of the scope of our organization, we will contact the author of the report so that they are aware.
Your courage in sharing will help strengthen our community and make it a safer place for all.
You will be asked at the end of this form if there is any course of action you prefer we take. We commit to respecting your wishes, unless we feel that an intervention is mandatory to prevent future harm.
All of your answers will be held strictly confidential unless you give explicit consent otherwise.
Where and when did this incident take place? Please provide the name of the event (such as during XYZ session/workshop, break for lunch, after dark, etc.), the date, and any specific details about when/where this occurred during the event.
What happened? Please provide a detailed description of the behavior you want to bring to our attention.
Have you followed up with the person(s) involved on your own?
Do you intend to follow up with the person(s) involved on your own?
I would like to, but request support.
What sort of response are you requesting?
I would like a facilitated mediation or clearing conversation with the person(s).
I want you to look into this on my behalf and follow up with the involved parties.
I want to speak with someone on the Consent Care team about this.
I just want to report the incident; no follow-up is needed.
You may remain anonymous if you choose.
However, if you would like for us to follow up in any way, please fill out the following details:
Your preferred contact email:
Were there other witnesses? If yes, please list them.
Is there anything else you would like to add?
Thank you for taking the time to share your story and for helping us build a stronger, safer community. We appreciate you.
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