ESC Racial Grievance Reporting Form
Please use this form to report a racial grievance to the Environmental Science Center; you may fill out this form anonymously. Alternatively you may request an in person follow-up. A member of the ESC Racial Grievance Committee will reach out to you within three business days to learn more about the incident and work with you to determine the next steps for addressing the grievance.  

This policy and reporting form are intended for racism that happens in connection with the Environmental Science Center.  We are a small organization and unfortunately do not have the capacity to address racism outside of our organization, volunteers, partners, and vendors.

The Environmental Science Center is committed to becoming an inclusive, anti-racist, multicultural organization engaging our community in environmental education and creating safe and affirming outdoor experiences for everyone.  The Racial Grievance Policy is intended to support People of Color to feel safe in the workplace, for participants to feel welcome during school and public programs, and to actively address and interrupt microaggressions, harassment, racial discrimination, and our racial misconduct.  
*Racial Grievance Policy and Reporting form adapted from Seattle Works and Tiny Trees
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Are you reporting a racial grievance about a racist incident that happened to you or someone else? *
If you are reporting for someone else, do you have their permission to report the incident? *
Name of person reporting the incident.  If you wish to report anonymously, please leave this blank
Contact information for person reporting the incident (email and/or phone number).  If you wish to report anonymously, please leave this blank.
Please describe the location, circumstances, date and time, 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 *
Add more information here if you have witnessed similar racist incidents before, with or without the same offender? To help our grievance committee keep track, please fill out separate forms for each incident.  *
Did you or anyone else take action to interrupt or address the incident? *
If yes, what action was taken and what was the result? *
If no, why was no action taken? *
Please use this space for any additional information you would like to share *
Would you like the Environmental Science Center Racial Grievance Committee to address the racial grievance? *
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