Email Consultation

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〇 Your Information

[Required] Affiliation:
Kyoto Tachibana University
Kyoto Tachibana Junior High School
Kyoto Tachibana High School
Tachibana Oji Kindergarten

[Optional] Department:

[Required] Disclosure of your name to Kyoto Tachibana Educational Institution
Anonymous / Real name (Full name:　　　　　　)

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〇 Contact Information
(Your contact information will not be disclosed to Kyoto Tachibana Educational Institution (hereinafter referred to as “the Institution”).)


[Required] Disclosure of your name to the consultation desk:
Anonymous / Real name (Full name:　　　　　　)

[Required] Email address:
A confirmation email will be sent to the address you provide.

[Required] Would you like to get a response from the Institution?
Yes / No

If you would like to get a response from the Institution, please choose either telephone or email.
If you prefer to be contacted by telephone, please provide your phone number.
If you prefer to be contacted by email, we will reply to the email address you provided above.

■ Email address: Same as above
■ Phone number:

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〇 What Would You Like to Consult About?
(The information you enter will be reported to the Institution as provided.)

[Required] Consultation category:
Harassment-related consultation
Mental health consultation

[Optional] Date or period of occurrence

[Optional] Location of occurrence

[Optional] Date or period when you became aware of the incident

[Required] Details of your inquiry
* For mental health concerns, please describe your current condition and possible causes in as much detail as possible.
For harassment concerns, please provide specific details including the nature of the behavior, frequency, when the incidents occurred, and when you became aware of it.

[Required] Request to the Institution
* Please describe any requests you have for the Institution. If your consultation is related to harassment and you request specific actions to be taken, please provide those details here.

[Required] Is anyone else aware of this matter? Yes / No

[Required] Do you have any supporting evidence? (For mental health consultation, please select “No”.) Yes / No

If you have any evidence, please attach it if possible.
Supporting evidence such as text data, URLs, and audio files will be forwarded to the Institution in their original form. If you wish to submit a consultation anonymously, please remove or redact any information that could identify you before submission.

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〇 Information About the Person Involved

[Optional] Affiliation:
Please select from the following: Kyoto Tachibana University, Kyoto Tachibana Junior High School, Kyoto Tachibana High School, or Tachibana Oji Kindergarten.

[Optional] Department:

[Optional] Position or job title:

[Optional] Full Name:

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