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Were you recently terminated, quit your job, or are you still employed?

When did this happen?(Answer the previous question first)

How long did you work there?(Answer the previous questions first)

What type of discrimination did you experience?(Answer the previous questions first)

How did the discrimination affect you at work?(Answer the previous questions first)

How often did the discriminatory treatment occur?(Answer the previous questions first)

When did the most recent discrimination incident occur?(Answer the previous questions first)

Did you report the discrimination to your employer, HR, or a supervisor?(Answer the previous questions first)

What was your employment status?(Answer the previous questions first)

What was your hourly wage?(Answer the previous questions first)

$per hour

Roughly how many employees does the company have?(Answer the previous questions first)

Please tell us what happened in detail:(Answer the previous questions first)

What is the name of your employer/company?(Complete the previous questions first)

Contact Information(Complete the previous questions first)