Community Justice Connect Online Form

Community Justice Connect is free, voluntary and confidential. Our program provides a variety of conflict resolution services to Indigenous, racialized, and religious minority communities throughout Newfoundland and Labrador.

Contact us, if you want to speak to someone first. This online form is confidential and for internal use only.

Instructions:

Keep it simple. Remember the character limit. Fill out the fields marked with an asterisk (*).
Do not send us any other information and/or documents unless we ask you to send it to us.

You will not be able to save this document. Fill it out all at once or answer the questions in a separate word document and then cut and paste your answers back into this Form. Cut and paste will not work if you use special characters (*&^%$#@)

Personal Information

Name*

First Last

Your preferred pronoun

Do you need any special accommodations?

The Human Rights Commission makes every attempt to provide reasonable accommodations up to the point of undue hardship. Using accommodations will not affect your process or be disclosed to anyone outside of our office. You will be treated the same way whether or not you make a request.

Your phone number*

Your email address*

What is the best way to contact you?

Do you self-identify as:*

Do you have an employee who self-identifies as:*

Please give us a brief description of the conflict and what happened to you?

Who was involved in this situation?

Is there anything else you feel we should be aware of?

Personal Information

Agreement