Anti-Asian Incident Report
The spread of the coronavirus has led to a rise in anti-Asian sentiment and actions. When you report an incident that happened to you through this form, you are helping AAF track these bias incidents in the tri-state area so that we can better advocate for the safety of our community and strengthen the response to these crimes.

If you have experienced a physical assault, physical menacing, verbal harassment/name-calling, being barred from an establishment or transportation, workplace discrimination, shunning, or other forms of racial bias, please tell us your story. We do not share your personal information with law enforcement or immigration. Your reporting will not put you at risk for deportation or affect your ability to apply for a green card or citizenship.

You may choose to report your story anonymously. All personal information will be kept confidential unless we explicitly receive permission from you. Thank you for being brave and coming forward and empowering others with your story. Please describe in detail what happened in the form.
1. Name: *
2. Email: *
3. Describe the incident: *
4. Date incident occurred: *
MM
/
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5. Time of incident: *
6. Site of incident: *
7. Location/Address of incident: *
8. State where incident occurred: *
9. Were the police called? *
10. Was a police report filed? *
11. Type of discrimination you experienced: *
Required
12. Suspected reason for COVID-19 discrimination: (check all that apply) *
Required
13. Ethnicity: *
14. Age: (optional)
Clear selection
15. Gender: (optional)
Check one or more options that reflect your gender
16. Phone: (optional)
17. Do you have pictures or videos of the incident? If yes, may we contact you for this information?
Clear selection
18. Provide any supporting links if available:
(news clips, social media sites, phone number of witness, etc.)
19. If you need for us to connect you with resources (victim services, mental health support, law enforcement), please share your phone number and email.
Submit
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