Bias Incident Submission Form

Equity and Inclusion Online Notification Form

This form is used to raise awareness about any bias situation or event believed to have a negative impact on ACPA members, particularly across marginalized social identity group membership. Bias is defined as: discrimination or harassment that denies particular activity or opportunity because of an individual's or group's perceived identity.

If you have an issue, comment, or complaint not related to bias, please do not use this form. Submissions can be sent to info@acpa.nche.edu or call (202) 780-9243 .

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Bias targets a marginalized identity whether real or perceived to be a part of a recognizable group or affiliation. Legally protected identities include: actual or perceived race, color, religion, national origin, gender, sexual orientation, gender identity, veteran status, or disability. ACPA also recognizes that bias may occur as a result of one’s actual or perceived age, ancestry, sex, gender expression, citizenship or immigration status, marital status, socio-economic class, or religious practice. The second list of identities are not legally protected identities in the United States but are affirmed through ACPA’s Core Values of diversity, multicultural competence, and human dignity.

Our intent is to use the Restorative Justice principles to resolve situations and conflicts that may be having an unintended negative impact across group membership. Our hope is also that all involved parties will engage in meaningful dialogue as we identify lessons learned.

Your responses can be anonymous unless you choose to include identifying information on this form or want someone to follow-up with you. If you choose to submit a report anonymously, we will not be able to engage you in the resolution process. You may choose to opt out of any resolution process at any point.

Thank you for your commitment to the ACPA community.

Details of the situation. Please describe the specifics of the situation that has you concerned, key people involved, as well as any possible impact across social identity group membership.

Date and Time of Situation

- Month - Day Year

at

: Hour Minutes

Location of Situation

Feel free to add any additional details concerning the situation that you believe would be helpful as we consider ways to respond.

Would you like someone from the ACPA International Office or the Director of Equity and Inclusion to follow-up with you?

Yes No, I want to remain anonymous.

Full Name

E-mail

Phone

If you would like more support, feel free to call the Equity and Inclusion line, (202) 780-9243, or email inclusion@acpa.nche.edu.

Thank you.