Incident Report
Please use this form to report any violation of our Safe Space Statement. 

This report will be kept confidential and discussed only at our executive board level. All investigation and actions taken will be documented. 
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Email *
Your name: *
Contact number: *
Contact email: *
MiA Event/Program where incident took place: *
Description of offense (include who, what, where, when) *
Name of Alleged Harasser: *
Witnesses to incident: *
Other important details: *
Do you understand that MiA will investigate this matter and take appropriate action? *
Do you want to be informed of the actions taken after the investigation? *
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