District Belonging & Inclusion Reporting Form

This form aims to summarize each concern reported at your district tournament. Please use the prompts below to provide information on the nature of the concern, the investigation, and decided corrective action.

Depending upon the nature of reported concerns, limited information may be shared with NSDA leadership, including but not limited to the Director of DEI, executive team, and/or Board of Directors. Relevant information may be made available to National Tournament Belonging and Inclusion Advocates in the case of a repeated violation.

District Name(Required)

District Date(Required)

Site(Required)

Belonging & Inclusion Advocate Name(Required)

Belonging & Inclusion Advocate Email(Required)

Were there any concerns reported at your district tournament?(Required)

Select "Yes" for the intake questions to appear.

Yes

Intake Information

Concerned Persons Name(Required)

First Last

Concerned Persons School(Required)

Respondent Name(Required)

First Last

Respondent School(Required)

Nature of Concern (e.g. inappropriate jokes, bullying)(Required)

Please provide a detailed summary of the meeting (e.g. interaction with the concerned person and subject of concern, recommended course of action etc.)(Required)

Do you have another concern to report?(Required)

Select "Yes" for the intake questions to appear.

Yes

Additional Intake Information

Concerned Persons Name(Required)

First Last

Concerned Persons School(Required)

Respondent Name(Required)

First Last

Respondent School(Required)

Nature of Concern (e.g. inappropriate jokes, bullying)(Required)

Please provide a detailed summary of the meeting (e.g. interaction with the concerned person and subject of concern, recommended course of action etc.)(Required)

Do you have a third concern to report?(Required)

Select "Yes" for the intake questions to appear.

Yes

Third concern Intake Information

Concerned Persons Name(Required)

First Last

Concerned Persons School(Required)

Respondent Name(Required)

First Last

Respondent School(Required)

Nature of Concern (e.g. inappropriate jokes, bullying)(Required)

Please provide a detailed summary of the meeting (e.g. interaction with the concerned person and subject of concern, recommended course of action etc.)(Required)

Do you have a fourth concern to report?(Required)

Select "Yes" for the intake questions to appear.

Yes

Fourth Concern Intake Information

Concerned Persons Name(Required)

First Last

Concerned Persons School(Required)

Respondent Name(Required)

First Last

Respondent School(Required)

Nature of Concern (e.g. inappropriate jokes, bullying)(Required)

Please provide a detailed summary of the meeting (e.g. interaction with the concerned person and subject of concern, recommended course of action etc.)(Required)

Please share any feedback, questions, or concerns you have about your experience implementing a Belonging and Inclusion Station at your district tournament.

Comments

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