EDIA Incident Reporting Portal

Thank you so much for taking the time to fill out this report. The more you are willing and able to share, the better we can address the issue, consult with you, and report back. Your feedback is extremely important to us, as it will help us hold ourselves and others accountable. Anything you offer through this form will remain confidential to the reviewers (and fully anonymous unless you indicate permission otherwise).

Equity, Diversity, Inclusion, and Anti-racism are core values to our organization—values that require a constant state of growth and learning. As we seek to create the most inclusive and welcoming space possible, we are committed to identifying and interrupting instances of harm at A Noise Within. To that end, we so appreciate your bravery and vulnerability in notifying us; your openness helps us learn and exercise accountability so we may improve for our community.

This form will be reviewed by Interim Managing Director Douglas Love-Ramos, and—if you have provided contact information below—you should expect to hear from us within 48 hours.

EDIA Incident Form

Please describe what happened.(Required)

Date of incident(Required)

Time of incident(Required)

Location of incident(Required)

Please list any additional people involved.

Do you have a desired action/outcome?

Name

First Last

We'd appreciate the opportunity to connect with you as we seek a resolution to this incident, but out of respect for your privacy, this field is optional.

Do you wish to remain anonymous to the parties involved in the incident?

Yes

If you select yes but have entered your name in the above field, your name will only be know by the appointed party handling the issue. Your name will not be shared with any parties involved in the incident.

Do you want to be contacted?

Yes

Optional

Phone

Optional

Which of the following best describes your relationship to A Noise Within?