1. Full Name:

   You may remain anonymous in making this report. However, providing limited identifying information may also limit our ability to respond.

2. Email Address (optional):
3. Phone (optional):
4. *Your Role: Fanime Staff - I was the target of an incident Fanime Staff - I was notified of an incident Fanime Staff - I witnessed an incident Fanime Staff - I was accused Not Fanime Staff - I was the target of an incident Not Fanime Staff - I was notified of an incident Not Fanime Staff - I witnessed an incident Not Fanime Staff - I was accused Other

   If 'other', please clarify in the "additional information" field.

2. How would you classify this incident? Medical Harassment Assault Other

   If other, please clarify in the "additional information" field.

3. *Please describe the incident with as much detail as possible.

   Please provide us with as much information as possible about the incident that you are reporting.

4. When did this happen?

   If you do not know the exact date or there are multiple dates, you may clarify in the "additional information" field.

5. *Where did this happen? In-Person Staff Meeting Fanime Zoom Meeting Another Type of Online Meeting Fanime Discord Servers Discord Direct Messages Convention Space - SJCC - Public Area Convention Space - SJCC - Staff Area Convention Space - Hyatt Downtown - Public Area Convention Space - Hyatt Downtown - Staff Area Convention Space - Hilton San Jose - Public Area Convention Space - Hilton San Jose - Staff Area Convention Space - San Jose Marriott - Public Area Convention Space - San Jose Marriott - Staff Area Convention Space - Westin San Jose - Public Area Convention Space - Westin San Jose - Staff Area Convention Space - Signia San Jose - Public Area Convention Space - Signia San Jose - Staff Area Convention Space - DoubleTree San Jose - Public Area Convention Space - DoubleTree San Jose - Staff Area Other Convention Space - Public Area Other Convention Space - Staff Area Unsure Other

   If other, please clarify in the "additional information" field.

6. *To help us understand how we can best assist you, please describe how you hope that we respond to the information you have provided:
7. *Would you like an investigator to follow up with you about this incident? Yes No
8. *Do you think the victim/target would like an investigator to contact them about this incident? Yes No Not Sure

1. Who else has been notified?

   Please let us know what other departments/individuals are aware of this issue.

   Check all that apply.

   None Supervisor Department Head Division Head Staffing Chair Team Board of Directors Local Police Security Other (please specify in 'Additional Information')
2. *How many Involved Parties? 1 2 3 4

   If you are the reporting party and you are not directly involved in the alleged incident, please do not include yourself.

1. How has this incident impacted you or others?
2. Additional Information

   If there is anything more to add or clarify, please let us know.

Information submitted here is not associated with your name or email address, unless you provide that to us.
Information submitted here is also subject to our privacy policy.

1. Thank you for taking the time to complete this investigation request form. These requests are sent to outside counsel for review. If needed (and if you provided your contact information), they may contact you for any additional information.

   Thank you for your time.

   Submit FanimeCon Investigation Request