Statement of Apology Date: MM DD YYYY Person(s) to whom this form is offered: Loved one Stranger Coworker Other If other: I understand that I have caused harm by: I acted in this way because: I understand that my actions caused: I feel _______ about my actions. Guilty Foolish Shame Fear Justified Other If other: From this experience, I've learned: Reason(s) for apologizing: Got caught To feel better Because it's "right" Healing Why not? Other I will be accountable to this apology by: Other next steps: Public apology Rehab/sobriety Resignation Therapy Compensation Other If other: Additional notes: By submitting this form, I acknowledge responsibility for the harm I've caused and ____ take steps to prevent repeating these behaviors in the future. I will I won't Please file under: * Ableism/Sizeism Classism Homophobia/Transphobia Interpersonal Harm Racism Sexism Thank you!