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Would you like to be anonymous in reporting this incident? (Remember, unless you give permission otherwise, your communications -including that you made a contact- are confidential).

Would you like this incident to remain confidential to the CHM Student Resolution Advocate?

Do you want this incident investigated or do you just want us to be aware of the incident?

Do you hope for a particular outcome given this report and/or interaction with the Student Resolution Advocate? 

Which campus or community are you in?

What academic year, level or program are you in?

May the Student Resolution Advocate contact you?