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1. Name (Optional)

The ACNP will accept anonymous complaints and/or reports of harassing conduct in violation of this policy. Without the identity of the alleged victim and/or complainant, however, it could be difficult to corroborate the conduct alleged.

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2. Contact Information (Optional)

The ACNP will accept anonymous complaints and/or reports of harassing conduct in violation of this policy. Without the identity of the alleged victim and/or complainant, however, it could be difficult to corroborate the conduct alleged.

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3. Name of Alleged Offender

(If you are unable to provide a name, please describe the individual's physical appearance in as much detail as possible.)

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4. Name(s) of individual(s) who experienced or witnessed the incident

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5. Time and Date of Incident

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6. Location of Incident

If online, please state the platform.

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7. Nature of Incident

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8. Comments

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9. Additional Information

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