Department Climate Feedback Form
The purpose of this form is to provide you with the opportunity to provide feedback on the Department of Physics' efforts to build a supportive and welcoming community.
Please feel free to leave anonymous feedback or to leave us your contact information so that we can follow up.
Feedback/Comment/Question/Suggestion concerning Departmental Climate:
Email Address (optional)
Would you like to be contacted for follow up?
If yes, you must include your email address.
Only if it's deemed necessary by the department.
Would you like to set up a one-on-one appointment with someone on the committee?
The diversity and climate committee would love to hear from you in person. If you would like a meeting, let us know. Meetings can be arranged with faculty, grad students, undergrad students, or staff on the committee depending on who you are most comfortable with. You must submit your name and contact information for us to email you for meeting times and committee members available.
Preference for submitting this form:
Entire Diversity and Climate Committee may view my feedback form.
Only staff member and chair of the Diversity and Climate Committee may view my feedback form.
Your response will be seen by a staff member of the Diversity & Climate Committee and the committee chair, and may be shared with the full committee unless indicated otherwise on this form.
To learn more about mandatory reporting, please visit
If you witness any improper or disrespectful behavior then we encourage you to report it to one of the following entities:
- report an incident of hate or bias
- report sexual/gender harassment, discrimination, and assault; dating and domestic violence; stalking; invasion of sexual privacy
- report diversity-based discrimination
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