MEChA de UCLA Incident Report
This is an incident report form for members of MEChA de UCLA as well as individuals not associated with the organization to report any harm done onto them by members of the organization and members outside the organization.

This form is completely anonymous if you choose that, and there is the option to include your name and contact information if you would like.

We have also attached our organization's Sexual Harassment Protocol. The SH Protocol outlines the process that we will go through as an organization in order to hold the individual who committed harm accountable, in consultation with the survivor if they are at capacity. If the survivor does not want any portion of the protocol to be followed, it is within their full discretion and we will respect their wishes fully. The Protocol also outlines resources for survivors, as well as provides educational resources if folks are looking for that.

If you have any questions, feel free to contact our Gender & Sexuality Coordinator at, our Chairperson at, or our Internal Vice-Chair at
*If you wish to ask anonymous questions please visit our MEChA de UCLA Incident Report Questions Form here:

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Survivor's Name
Name of Individual who committed harm 
Reporter's Name
Reporter's Contact Information
Incident Description
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