I Am A Writing Center Client & Would Like to Discuss A Concern: Use This Form

All members of the Writing Center community are expected to adhere to Writing Center Community Standards, whether online or on a GW campus. If someone related to the Writing Center — client, FOA, or consultant — engages in unacceptable behavior (whether you witnessed what happened or experienced it directly, whether the incident seems major or minor to you) please submit this report.

What Will Happen After I Request to Discuss This Form?

If I File a Form, Am I Protected From Retaliation?

Thank you for reaching out to the Writing Center to let us know about your concerns. The Director -or- Deputy Director will follow up within the next two business days

Today's Date

Your Name

Your Email Address

Would you prefer that the Director withhold your name in any discussions with the people involved in the incident?

Yes

Who was involved in the incident? For example, if you’re writing about a Writing Center client, please share their name (if known):

If you don’t know the name of the person, please describe their function in the Center (Consultant? Person at the front desk? Administrator?). Please also describe the individual(s) in as much detail as possible below in your narrative. This could include the person's age, sex, physical appearance/characteristics (height, weight, skin tone, hair color/texture, eye color, facial hair, etc.) as well as a description of their clothing, accessories, and any distinguishing features or characteristics. [These questions borrow from the GWU Bias Reporting website]

Names of Witnesses, if any:

Date/Time of Appointment or Incident

Check if this a follow-up to a previous report

Date of Previous report

Did the incident involve unwanted touch?

Title IX Mandatory Reporting NOTE: If you respond “yes,” the director is legally obligated to submit a report on this incident to the GW Title IX office.

Yes

If yes, did the touch feel sexual in any way?

NOTE: If you respond “yes,” the director is legally obligated to submit a report on this incident to the GW Title IX office.

Yes

Please describe what happened

What support do you need?

Submitting this report is all I feel I need at this time. This felt like a small incident, but I wanted to let you know.

Let’s talk. There’s more than I can include in this form and I might want to discuss next steps.