NCECA REPORTING FORM

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Any reports of harassment occurring during the course of NCECA programming will be investigated, including those submitted anonymously. Reports of incidents that occurred outside of NCECA programming may be beyond NCECA's scope of inquiry will be reviewed and may be of value in informing future decision-making.

No information submitted on this form or during the related investigation will be shared with anyone who does not have a legal or legitimate operational need to know.

This form may be used by employees, consultants, contractors, interns, presenters, exhibitors, subcontractors, vendors, volunteers, other persons providing services pursuant to a contract, and anyone who participates in our programs to submit a report.

You will receive a confirmation email that we received your report within 7 business days of submission if you provided your contact information. The processing of each report is specific to the content of the report.

REPORT INFORMATION

Please use the spaces below to describe the person(s) and incidents about which you want to report.

Please tell us your name.

Name(s) of person(s) involved:

Please describe your relationship to NCECA:

Relationship of others cited in your report to NCECA:

Please describe what happened. You may use additional pages, but this information does not need to be detailed.

Date(s) conduct or incident(s) occurred:

YYYY

Is the conduct continuing?

If you reported similar conduct previously, please include below the date(s) of your report(s) and how or to whom you reported it.

We may need to contact you personally to discuss what additional information you might have that would help us to investigate your report. Please add anything else you would like us to know at this time.

OPTIONAL: If you desire follow up, please include the best email address to reach you:

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