Community Concern Reprot

We take all community concerns seriously and carefully review every report. After you submit this form, we may contact you for additional information or request photos or copies of the correspondence as supporting evidence.

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Name *

First

Last

Your Member ID *

Your Email *

was like your

Phone Number

Person of Concern Name *

Person of Concern Member ID *

What is your concern? Select all that apply.

Made me feel uncomfortable or unsafe
Unkind or disrespectful communication
Criticism, shaming, or manipulation
Personal boundaries were ignored
Pressure to respond or share information
Unwanted religious or political persuasion
Repeated or unwanted contact
Harassment, intimidation, or stalking
Threats or encouragement of violence
Hate speech or discrimination
Sharing of private information
Sexual or illegal material
Fraud, scams, or impersonation
I’m not sure which option applies
Other

Other

Please describe what happened. Include any details, what was said or done and about when it occurred.

What would you like us to do. Select all that apply.

Keep a confidential record of my concern.
Do not match me with this person again.
Contact me to discuss what happened.
Ask the person to stop contacting me.
Review the situation and take appropriate action.
I am unsure and would like help deciding.
Other

Other

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