|
BIOGRAPHIC INFORMATION
|
|
Name (Optional):
|
|
|
E-mail (Optional):
|
|
|
Phone (Optional):
|
|
|
Age:
|
|
|
Gender:
|
|
|
Classification:
|
|
|
Race:
|
|
|
Sexual
Orientation:
|
|
|
Religion:
|
|
INCIDENT INFORMATION
|
|
|
|
|
Location of Incident:
|
|
|
Date Incident Occurred:
|
|
|
Others Involved:
|
|
YOUR STORY
|
1. Have you personally
witnessed any act(s) of insensitivity, intolerance, or
discrimination on Elon's campus that was related to
race, gender, culture, national origin, religion,
social class, sexual orientation/identity, physical and
learning ability? If yes, please describe the incident
in detail.
|
|
|
2. How did the incident
make you feel?
|
|
|
3. Did you share this
experience with anyone (friend, family member, Elon
student, faculty or staff)? What were their
reactions?
|
|
|
4. After sharing the
incident, did you feel there was understanding and
support expressed by the person you shared the incident
with? If yes, give examples.
|
|
|
5. After sharing the
incident, did you feel there was lack of understanding
and support by the Elon person? If yes, give
examples.
|
|
|
6. What did you learn from this situation and what do
you think others can learn from this
experience?
|
|
|
By being checked, I
give my
permission for the content of this form to be archived
in the Elon Univerity Multicultural Center and Belk
Library of Elon University.
|
|
|
