Questions to Record Racism

Submitted by Visitor on Sun, 2006-11-05 08:26.

What is the questionnare about?
This questionnaire is to provide a venue for people who have experienced unfair treatments and racial discrimination to share their experiences on the incident, how they deal with the situation and what were some of the barriers, as well as suggestions for change or actions.

What do you like to share?

Participants have the choice to share their experiences [in whole or in part] depending on the situation and the comfort level and needs of the participant.

What is it used for?

Data collected by the ECCC will be kept in strict confidence, aggregated data may be used for addressing policy issues or systemic change purposes.

Need Someone to Help?

Please contact our multi-cultural brokers if you prefer to file information verbally or need assistance to fill the questionnaire. You can reach us at (403) 263-9900.

Thank you for your commitment to ending racial discrimination in Calgary; you are not alone.

Together we can and will make a difference.

Your Name:

First Name: *

Last Name: *

Your Contact Info:

Address:

Phone:

E-mail:

Incident Info:

Location:

Date

Time

Your Story:: *

Did you contact police?

What did they do or say regarding your case?:

Did you get the assistance or support you were looking for?:

Did you contact the Alberta Human Rights Commission

What did they do or say regarding your case?:

Did you get the assistance or support you were looking for?:

Other Contacted Person/Group

Who did you contact for support?:

Were they helpful as a support?:

In what ways were they helpful?:

If you did not contact anyone, what stopped you from doing so?:

How has this incident affected you?:

Was this the first time this happened to you or were there other incidents?:

How did you hear about us?:

Do you know others that have had a similar experience to yours?:

If yes, please briefly describe their experience:

What actions do you wish to take?:

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