BIPOC Base Safe Space Access Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

*Please note you do not get access immediately after completing this form. This form is not monitored 24/7. Please wait for 3-5 business days to be granted access. Thank you for understanding*

Please complete this form to be granted 24/7 access to BIPOC Department safe space (BIPOC Base) via your student card.

Email *

Full Name *

University ID Number *

I have read and understood the BIPOC Safer Spaces Policy (linked here). *

Yes

I agree to abide by the BIPOC Safer Spaces Policy and any other rules or regulations applying in spaces managed by the BIPOC Department from time to time ('Codes of Conduct'). *

Yes

I understand that if I do not abide by the BIPOC Safer Spaces Policy, I am liable to face consequences, including but not limited to removal from spaces managed by the BIPOC Department. *

Yes

I identify as a BIPOC student and I understand that BIPOC Base is an autonomous space reserved for students who self-identify as one or more of the following: Bla(c)k, Indigenous and/or People of Colour.*

*This definition includes, but is not strictly limited to: mixed-race or multi-racial people, and people who are white-passing (i.e. perceived to be white due to skin colour and other identifying features).

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms