The personal information you provide is collected under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act. Your personal information will be retained and used to determine whether we can respond to your request for assistance and, if so, to proceed accordingly. Your information may also be used anonymously for statistical and reporting purposes.

Your personal information is considered confidential and we will not share it with anybody else without your permission unless:

Disclosure is necessary to respond to your request for assistance;
Disclosure is required or authorized by law; or,
Compelling circumstances exist that affect anyone’s health or safety.

If you have any questions or concerns about how your information will be collected, used or disclosed, or would prefer to request an appointment without using this form, please contact a Human Rights Advisor directly by emailing humanrights@equity.ubc.ca.

Please specify your name:(Required)

First Last

Please specify your affiliation, if any, with UBC:(Required)

Undergraduate student

Graduate student

Staff member

Faculty member

Post-doctoral candidate

Alum

Prospective student

Member of the wider community

Other

Please specify your campus:(Required)

UBC Vancouver

UBC Okanagan

UBC Robson Square

Centre for Digital Media

Faculty of Medicine Site Across BC

Asia Pacific Regional Office

Other

Preferred method of contact:(Required)

Phone

Would you like a copy of this submission emailed to you?(Required)

Yes

Phone(Required)

Email(Required)

Which of the following protected characteristics are you concerned about?(Required)

Please check all that apply.

Indigenous identity

Race

Colour

Ancestry

Place of origin

Political belief

Religion

Marital status

Family status

Physical or mental disability

Sex

Sexual orientation

Gender identity or expression

Age

Criminal conviction

Unsure

Please provide times that you would be available to speak with a Human Rights Advisor over the next two weeks:(Required)

Please note that we will contact you within two weeks to schedule an appointment with you.

This field is for validation purposes and should be left unchanged.