SUMMIT

REPORTING FORM FOR SEXUAL OR OTHER HARASSMENT

You do not have to use this form to receive assistance

The intention of this form is to provide Summit attendees with a mechanism to report harassment or other forms of harm.  This form is not intended to be used to receive immediate assistance or support. For immediate support, call (646) 809-4011.

If you believe you have been harassed by any member of the Summit community or while participating in a Summit program or activity, you are encouraged to bring it to the attention of the Incident Council (“IC”) or any other Summit team members, such as your Curator. 

The Incident Council is a group of fellow Summit Community members who have volunteered to adjudicate incidents and keep our community safe for all members.  All Council members have signed non-disclosure agreements and will keep these reports confidential.

This form is to assist with reporting an incident to the IC.  While it would be helpful for you to fill out this form, you are not required to do so in order to report an alleged incident of unlawful harassment.

The IC is available to provide you with answers to questions you may have about the process and your options, advice and/or referrals. [Email questions to report@summit.co] You are not obligated to provide your name; however, the ability of the IC to take action against an alleged harasser may be more difficult based on an anonymous report.  Whatever your decision, the IC or Summit team members are available to assist you in stopping the unwelcome and unwanted conduct.

Print version available here.


Name (optional)
Name (optional)
Address
Address
Phone
Phone
Name of person accused of harrassment *
Name of person accused of harrassment
Date(s) of alleged incident(s) *
Date(s) of alleged incident(s)
Were you able/comfortable to address your concerns with the person(s) whom you are accusing of harassment? *
Did anyone witness the incident?
Does anyone have knowledge of the incident?
I hereby certify that the foregoing information is true, correct and complete to the best of my knowledge and belief. *
Your name (signature) *
Your name (signature)
Today's date *
Today's date