NAHSL 2018 Conference Incident Report Form

Please use this form if you wish to report an incident of harrassment. You may choose to remain anonymous and offer as much detail as you feel comfortable. All reports and inquiries will be handled in confidence.

Question Title

* 1. Name (Optional):

Question Title

* 2. Today's Date:

Date / Time

Question Title

* 3. Date and Time of the Incident:

Date / Time

Question Title

* 4. Please describe the incident that occurred in as much detail as you feel comfortable offering (include names of key individuals, when possible):

Question Title

* 5. How would you like the committee to respond to the incident?

Question Title

* 6. Is there anything else that the committee should know?

T