Bias Incident Report Form
GatherDC strives to be and build a community guided by the values of diversity, equity, inclusion, and justice so
Jewish 20s and 30s can feel safe and valued as their unique selves. GatherDC knows it is imperative we make space for all Jewish young adults across the DMV so they can meaningfully discover authentic Jewish identity and find lasting Jewish community.
This form should be used by staff, lay leaders, and/or community members who have been the targets of, or who witness, a hate or bias incident conducted by a Gather staff member or lay leader, Gather community members, or involving someone with ties to GatherDC
A bias incident*
demonstrates an accused’s prejudice based on the actual or perceived race, ethnicity, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, gender identity or expression, family responsibility, homelessness, physical disability, matriculation, or political affiliation of a victim of the subject designated act.
Upon filling out this form, the content will be sent to Julie Thompson, GatherDC's Operations Director and a member of GatherDC's Antiracist Accountability Group. If you choose to provide an email for follow-up, someone from GatherDC will reach
out to you directly to discuss the options available for resolution of your report and how you would like to proceed. If no contact information is provided, GatherDC commits to following up on the report within 24 hours of its submission date with further investigation and appropriate action.
Your confidentiality and trust is incredibly important to us, and we commit to making every effort to protect your privacy;
however, in very limited circumstances involving the safety or immediate threat to someone, we may not be able to guarantee complete anonymity. We can promise, however, that all matters will be handled with the utmost discretion and any information that must be shared will only be shared with individuals with a legitimate need to know.
If you are unsure or would like to speak to someone about completing a bias incident report, please contact
*This definition of a bias incident is taken from the Bias-Related Crime Act of 1989 (D.C. Official Code § 22-3700 et. seq.)
Date of Incident
Time of Incident
Who was primarily targeted in this incident?
Who were the primary perpetrators in this incident?
Were there any witnesses? Who? If possible, please provide contact information.
Please provide a detailed description of the incident using specific, concise, and objective language (Who, what, where, when, why, and how).
Please attach any supporting documentation of this incident you wish to share.
Would you like to be contacted by a member of the GatherDC staff about this incident?
Please confirm you included contact information for further follow-up
Yes, I included my phone number and/or email in the Background section.