Statement of Pardon Date: MM DD YYYY I was hurt when you: I experienced your actions as harmful because: As a result of your behaviors, I experienced: When I think about your actions, I feel: Sad Angry Powerless Scared Ashamed Foolish Nothing: I never think of you Other If other I think that you acted as you did because of: I don't care I don't understand Trauma Privilege Anger Fear Other If other: What I'd like from you: I hope you can be accountable to me and our communities by: Before acting in the future, I hope you consider: I: have received an apology from you. have not received an apology from you. hope to receive an apology from you at some point in the future. Additional notes: After filling out this form and further reflecting on my feelings, your behaviors, and larger societal systems, I _____ pardon you. do do not Please file under: * Ableizm/Sizeism Classism Homophobia/Transphobia Interpersonal Harm Racism Sexism Thank you!