Code of Conduct Review Committee Submission Form

Code of Conduct Review Committee Submission Form
Instructions:

Please complete this form to the best of your ability. Include any uploads of documentation that you believe will help the committee understand your situation. Once you submit the form, the Code of Conduct Review Committee and SIA Staff will review your submission and may be in touch.
Your Name:

First NameLast Name
Your Email address:
example@example.com
Your Region:
Your Club:
America del Sur Region
Your Club:
Brazil Region
Your Club:
Camino Real Region
Your Club:
Central East Coast Region
Your Club:
Deset Coast Region
Your Club:
Eastern Canada Region
Your Club:
Founder Region
Your Club:
Golden West Region
Your Club:
Japan Chuo Region
Your Club:
Japan Higashi Region
Your Club:
Japan Kita Region
Your Club:
Japan Minami Region
Your Club:
Japan Nishi Region
Your Club:
Korea Region
Your Club:
Mexico/Centroamerica Region
Your Club:
Midwestern Region
Your Club:
North Atlantic Region
Your Club:
Northwestern Region
Your Club:
Peaks to Plains Region
Your Club:
Philippines Region
Your Club:
Sierra Nevada Region
Your Club:
Sierra Pacific Region
Your Club:
South Central Region
Your Club:
Southern Region
Your Club:
Taiwan Region
Your Club:
Western Canada Region
Your Title (if applicable):
What language(s) do you speak well enough to attend a virtual meeting in?
What kind of issue would you like to submit? Check the box that best describes the issue.
Please explain that situation that occurred and any attempts to resolve the situation. Including any full names, dates, times, witnesses, and factual explanations of what occurred will be most helpful. If law enforcement/any other authorities have been contacted, please include that information.
If you have any documentation to submit, please upload it in the box below.

Cancelof
I understand that by signing/typing my signature on this form, I agree that everything I have shared is true and complete to the best of my knowledge and understanding. I understand that the CCRC may take several weeks to complete an investigation and render a decision (which will be expedited in severe circumstances). I agree to be available via email, phone call, or scheduled virtual meeting to further discuss this submission if needed.
Name:

First NameLast Name
Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: