ACADIA Code of Conduct Violation Report

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The more information you can provide us with, the better the investigation we'll be able to conduct.

All reports will be followed up promptly, with further investigation conducted where needed. In conducting its investigations, ACADIA will strive to keep the identity of the individual making the report as confidential as possible beyond the investigation.

This form will not collect your email address; please save your own copy of your responses before submitting.

* this form is based on the reporting form provided by ACM (Association for Computing Machinery)

Date of Incident *

YYYY

Where did the specific incident occur? *

What type of violation are you reporting? (Select all that apply) *

Sexual harassment (eg. unwelcome attention and/or inappropriate contact)

Discrimination (eg. acts of racism, sexism, or homophobia)

Invasion of privacy (eg. intrusive and/or unwanted behavior)

Violence or threatening behavior

Disruptive behavior

Other:

Required

How were you involved in the incident? *

I was directly involved

I witnessed the incident

I heard about the incident from someone else

What happened? (Please share with us the details of what, when, and where) *

Please identify the person(s) involved in the incident. **(If you wish ACADIA to investigate the incident, please also include your name. Your name will not be shared with the person or persons involved in the incident, but your name is needed for a thorough investigation to proceed) *

Is there anything else that you'd like to share?

Please include phone and/or email if you would like ACADIA to follow up with you.

If you prefer not to be contacted, please indicate below

I do not wish to be contacted

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