EndRacism Reporting Form

EndRacism Reporting Form Your Right. Your Responsibility.

Have you seen or heard something that upsets you, makes you feel unsafe, or affects safety at school? Share your experiences and help make a positive impact. Speak up & stop racism!

This anonymous safety tip line reporting tool is designed for you to report any instances of racism involving NCSS staff or students. NCSS will use this information to gather data and take action. Your responses are treated as confidential, and you do not have to provide your name unless you want to. If you do decide to share your name or email address, it will only be used for communication purposes and nothing else.

File a EndRacism Report

(Note: EndRacism reports are only monitored during your school’s operational hours. If this is an emergency or you or someone you know is in danger, call 911 immediately.

Which school did this happen at?

On what date did the incident take place? (If you don't remember specific dates, select the month in which the incident occurred)

Where did the incident take place?

What is/are the name(s) of the person(s) involved? (student, teacher, administrator, colleague, board member, school staff, parent, etc.)

What is your role in the school system?

What is your ethnic or cultural origin(s)?

Please describe your story/situation. Be as specific and detailed as possible.

Did anyone else witness this?

Yes

Please provide witness name(s)

Have you reported this to anyone else?

Yes

Please provide name(s)

Do you want to leave your name and contact info?

Yes

Name

First

Last

Phone

Would you like to be contacted about your story?

Yes

Do you have any images, videos or screenshots that may help with your report? If so, please upload any supporting documents

Drop files here or

Max. file size: 6 MB, Max. files: 3.

“Do not attach intimate images or content. One file only per upload. 2 MB limit. Allowed types: png gif jpg jpeg mp4 mov

EndRacism Reporting Form

EndRacism Reporting Form Your Right. Your Responsibility. Have you seen or heard something that upsets you, makes you feel unsafe, or affects safety at school? Share your experiences and help make a positive impact. Speak up & stop racism! This anonymous safety tip line reporting tool is designed for you to report any instances of racism involving NCSS staff or students. NCSS will use this information to gather data and take action. Your responses are treated as confidential, and you do not have to provide your name unless you want to. If you do decide to share your name or email address, it will only be used for communication purposes and nothing else. File a EndRacism Report (Note: EndRacism reports are only monitored during your school's operational hours. If this is an emergency or you or someone you know is in danger, call 911 immediately.

Which school did this happen at?

On what date did the incident take place? (If you don't remember specific dates, select the month in which the incident occurred)

Where did the incident take place?

What is/are the name(s) of the person(s) involved? (student, teacher, administrator, colleague, board member, school staff, parent, etc.)

What is your role in the school system?

What is your ethnic or cultural origin(s)?

Please describe your story/situation. Be as specific and detailed as possible.

Did anyone else witness this?

Yes

Please provide witness name(s)

Have you reported this to anyone else?

Yes

Please provide name(s)

Do you want to leave your name and contact info?

Yes

Name

First Last

Phone

Would you like to be contacted about your story?

Yes

Do you have any images, videos or screenshots that may help with your report? If so, please upload any supporting documents

Drop files here or

Max. file size: 6 MB, Max. files: 3.

“Do not attach intimate images or content. One file only per upload. 2 MB limit. Allowed types: png gif jpg jpeg mp4 mov

Together, we can all work towards preventing racism and creating positive change.

For more information, refer to