Glow Incident Reporting Form

The Glow Centre’s Incident Reporting System allows members of the University of Waterloo community to anonymously report issues they have encountered on campus with respect to sexual and/or gender identity.

The goal of this service is to make departments and services on campus aware of recurring issues and to help to resolve these issues. As well, we hope to ensure that students have adequate support and guidance in navigating the university conflict resolution processes.

Examples of Incidents that Glow would like to know about:

  1. A queer student goes to health services for a pap test and the doctor tells them they do not need one.
  2. A professor repeatedly calls a trans student by their birth name, when the student has told the professor what name they want to be called by.

Using this form, and requesting a peer advocate, do not necessarily mean all issues reported will be resolved.However, Glow executives and peer advocates will do our absolute best to ensure all issues reported are used for advocacy purposes to make campus safer for queer & trans students.

We will also support all students seeking assistance to the utmost of our ability. However, we do encourage you, should you feel issues are not being resolved, to contact the campus Director of Equity for assistance.

This program is not intended to, and will not, address individual concerns that do not directly relate to sexual and gender diversity. An example of an incident that would not be followed up on is: a student is suspected of academic dishonesty and is looking for information regarding the academic appeals process.
If the issue is an emergency in which you feel your safety is at risk, please consider also contacting campus police.

Issue was with:

or, Other:

Where did the incident take place (i.e. classroom, building, residence, floor):

Please describe the incident/issue:

Would you like Glow to support you in addressing this incident through the assistance of a Peer Advocate?
 Yes No

If Yes, please provide the following information:

Name:
Email:
Primary Phone:

Would you like Glow to report the incident on your behalf without providing any identifying information?
 Yes No

By submitting this form, you are allowing Glow to use this information, without any identifying information, in its advocacy for improving campus life and access to education for queer and trans students.

Thank you for submitting to Glow’s Incident Reporting System. If you have requested a peer advocate one of our volunteers will be in contact with you within the next week.

Other Resources

Below is a list of resources on campus and in the KW area:

The University of Waterloo Police Service
519-888-4911
https://uwaterloo.ca/police/

Counseling Services
Needles Hall, room 2080
519-888-4567 x 32655
519-888-4096
https://uwaterloo.ca/health-services/
https://uwaterloo.ca/counselling-services/

Conflict Management and Human Rights
MC 4048
519-888-4567 x 39526
https://uwaterloo.ca/conflict-management-human-rights/

Student Success Office
South Campus Hall, second floor
519-888-4567 x 84410
https://uwaterloo.ca/student-success/

Women’s Centre
Office: Student Life Centre (SLC) 2101 above the Bomber
519-888-4567 x 33457
http://www.feds.ca/women/

Sexual Assault Support Centre of Waterloo Region
201-151 Frederick St., Kitchener, ON N2H 2M2
24 Hour Support Line: 519-741-8633
Office: 519-571-0121
http://www.sascwr.org/