Anti-Hindu Hate and Hinduphobia Incident Form
Hi
Email address *
PERSONAL INFORMATION
Who experienced this incident? If the incident involved a temple or other property, please include the name/phone/email of the primary contact person.
First and Last Name *
Phone Number *
INCIDENT
In filling out the description of the incident, please be as thorough as possible. Please include a description of the perpetrator(s), as well as exactly what was said or written by the perpetrator(s), if anything.
Date of Incident *
MM
/
DD
/
YYYY
Time of Incident *
Time
:
Location of Incident *
Please provide city and state.
Nature of Incident *
Required
Detailed Description of Incident *
Was the incident reported to law enforcement? *
If yes, what law enforcement agency?
Please include contact details for the representative of the law enforcement agency.
Was the incident reported to the media and/or community organization(s)? *
If yes, what media outlet(s) and/or community organization(s)?
Please include contact details for the representative from the media outlet or community organization.
A copy of your responses will be emailed to the address you provided.
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