Web of Change Incident Report Form
At Web of Change, we seek to live our values in community, as demonstrated through our words and actions. As outlined in our Participant Agreement and Reporting and Accountability Process, we take incidents of harassment and assault very seriously.

This form is intended to be a confidential avenue through which people who have experienced a violation of our community values can inform us of the situation. It exists as an independent mechanism through which you can inform us of something you have experienced. If you wish to remain anonymous you may do so, however we ask that you find someone to speak on your behalf (without revealing your identity) so that we have a way to keep in touch and ask follow-up questions. We will do our best to keep this information confidential. For more information on how we handle reports, please see our full Participant Agreement and Reporting Policy: http://bit.ly/WOCpolicy.

Your information
What is your first name? *
Your answer
What is your last name? *
Your answer
What is your phone number? *
Your answer
What is your email address? *
Your answer
Are you filing this on behalf of yourself or someone else? *
Your answer
The incident
Where did the incident take place? (Note - if the incident occurred online or in virtual space, please choose "Other")
What is the first name of the aggressor?
Your answer
What is the last name of the aggressor?
Your answer
To the best of your ability, can you estimate the date and time the incident occurred?
Your answer
Please tell us about the incident in question. What did you experience?
Your answer
Are there other details you would like to share to help us understand why this incident violates WOC's Participant Agreement and/or Community Values?
Your answer
Is there anything else we should know?
Your answer
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