Shuswap Immigrant Services Society

Welcome to the Shuswap Anti-Racism Portal. This is the reporting form to make a report of discrimination you have experienced or witnessed an incident of discrimination against others. The information you provide will be kept confidential.
Description of incident. In your words, please tells us what happened.
To the best of your ability, please describe what the perpetrator did, say, etc.? What words were said?
Where did this happen? For example, downtown Salmon Arm, at a cafe, at school, etc.
What was the date of the incident? Roughly what time did the incident occur? For example, "around 9:30 am on January 15, 2020."
Did anyone help the victim during the incident? If yes, what kind of help was provided and by whom?
What happened after the incident to the victim? What did the perpetrator do or say?

The person reporting the incident is:*
- The direct victim in the incident
- A witness of the incident
- The victim and witness in the incident
Please tell us how you were both the victim and the witness?
Please describe what happened to you as a victim in this incident such as what happened to you directly?
As a witness, what did you see, hear, smell, touch, experience during the incident?

As the victim reporting this incident, is this the first time this kind of incident has happened to you?*
- Yes
- No
You answered this isn't the first time you experienced this kind of incident. How many times has this happened to you before in the Shuswap area?
Did you report past incidents?*
- Yes
- No
To whom or where did you report past incidents? If possible, please provide the month and year of incident and where report was made. For example, March 2019, racist verbal assault on the bus, reported to police and to a roommate.
What were the reasons for why you did not report past incidents of discrimination you had experienced?
What is the victims Postal Code?
As the witness reporting this incident, is this your first time experiencing this kind of incident?*
- Yes
- No
Please provide how often you witnessed incidents like this over the past 12 months before the current incident?
What is the witness's Postal Code?

It would be helpful to have brief details of the people involved in this incident.
The Perpetrator
"Race" Status
Gender
Age
The Victim
"Race" Status
Gender
Age
The Witness
"Race" Status
Gender
Age
Is there anything else that we should know about your experience of this incident?

Sometimes victims and witnesses have feelings and thoughts about the incident that they would like to talk to others about to feel better. Would you like to talk to someone about the impact of this incident on you?*
- Yes
- No
You answered that you would like to talk to someone about the impact of this incident on you. Please provide contact information so we can reach you to provide information.
First Name*
Email*
Phone

Anti-Racism Portal