Report Race-Based Incidents at RCDS
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Please keep my response anonymous.
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Are you reporting a grievance about a racist incident that happened to you or someone else?
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If you are reporting for someone else, do you have their permission to report the incident?
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Name of person reporting the incident. If you wish to report anonymously, please leave this blank.
What is your class year? This will help us report data. If you wish to not include this information, please leave this blank.
Contact information for the person reporting the incident (email and/or phone number). If you wish to report anonymously, please leave this blank.
Date and time of incident
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DD
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Location: classroom or area where incident occurred
What happened? Please describe the circumstance and description of the incident. If you are reporting on behalf of someone else, please include their name if you have permission from them.
Name of offender(s), if known
Use this space to provide any other information about the offender.
Have you experienced or witnessed a similar incident before, with or without the same offender? If so, please describe here.
Was there follow up to this incident? If yes, please describe.
Is there any additional information you would like to share?
Would you like to follow up/meet with someone from RCDS?
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How do you identify racially and/or ethnically? This will help us report data. If you wish to not include this information, please leave this blank.
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With which gender do you most identify? This will help us report data. If you wish to not include this information, please leave this blank.
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