Discrimination and Harassment Advocacy Incident Form

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Please fill out this form to alert the Discrimination and Harassment team of an incident you have experienced. Any student at Columbia can fill out this form regardless of work status.

See here for a flowchart describing the potential steps you can choose to take if you are seeking recourse: https://bit.ly/3JyzXd1

Based on your response, an advocate from the Discrimination and Harassment working group will reach out to you for an initial discussion to speak more about any details of your experience that you would like to share with us. Once you fill out this form, you can expect to hear from us within 72 hours. Once having reached out to you we will delete the form data and wipe the information. If you would like us to stop contacting you for any reason and at any point, please speak to the working group member who has contacted you.

Your responses here will be visible to members of the NDH working group.

If you have questions please contact the working group here: ndh@studentworkersofcolumbia.com

Untitled Title

Name, current year, department, and school (please use an alias if you would prefer):

How would you like to be reached to set up an initial one-on-one discussion?

Please list any option you would like, such as: Columbia email, non-Columbia email, text message, Signal, Discord, or other messaging medium, along with the specific number, username, or address, in the space below. However, we recommend that you do not use your Columbia address.

If you are currently busy or on vacation, or have very specific dates and times that you are presently free, or would like to be contacted only after the beginning of the fall semester, please let us know in the space below.

For logistical purposes, please let us know your initial discussion preference (please check all that apply)

In-person, on campus

In-person, off campus

Remote, via video call (non-Columbia Zoom or Meet)

Remote, via phone call

Email only

Text only

Other:

Would you prefer that all contact or conversations with you from this point on are not recorded or written down anywhere, including in our confidential database?

Yes, please do not record or write down anything

No, I'm ok with being recorded for internal union purposes

Maybe/I'm not sure yet

Other:

Clear selection

Would you like the member who contacts you to discuss non-university resources for survivors with you?

Yes

Clear selection

Are you interested in seeking funding to find a new advisor?

Yes

Maybe

Clear selection

Do you have any specific exceptions to or preferences for who you would like to be contacted by?

e.g. “I don’t want to be contacted by a member of my department” or “I only want to be contacted by a BIPOC-identified worker”. You may also use this space if you want to list specific people you do not want to be contacted by.

Optional: If you would like to simply relay or summarize your experience before speaking with an advocate, you can do so in written form here.

Is there anything else you would like us to know that would make things more comfortable for you?

Submit

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