Request edit access
[Asian Voices Europe] Survey on Coronavirus racism in Europe (Version 1.0)
We, Asian Voices Europe, are collecting incidents of racism experienced by Asians in Europe, to be shared with journalists, embassies and anti-discrimination organizations in Europe. You can report your experience anonymously – Even if you do write your name, it will be deleted when we share the information with others. You can choose to reply in English, French, Japanese, Korean or Mandarin.
최근 코로나바이러스와 관련된 인종차별에 관한 사례를 모으고 있습니다. 유럽 현지 기자, 대사관 및 반차별 운동 단체들과 공유할 예정이며, 이름을 기입하셔도 익명으로 데이터화할 예정입니다.

Sign in to Google to save your progress. Learn more
Name (you can choose to remain anonymous in the next question) 성함 (다음 질문에서 익명화 선택 가능) *
Please indicate if you'd like to remain anonymous 익명으로 접수하시겠습니까? *
Your gender 성별 *
Your nationality 국적
Your age group 연령 *
Date & Time of Incident (mm-dd-yyyy) 사건 날짜 및 시간 (월-일-년도) *
Date
Time of incident 사건 발생 시간 (예: 오후 4시-6시 사이) *
Time
:
Location - Place 사건 발생 장소 (예: 카페, 길거리 등) *
Location - City 사건 발생 도시 *
Location - Country 사건 발생 국가 *
What is the gender of the harassers? 가해자 성별 *
How many people were involved? 가해자 수 *
Please write what happened in as much detail as possible 사건 설명 (가능한 한 상세하게 부탁드립니다) *
Would you like us to contact you regarding your incident? If so, you leave an email address.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms