Hindu American Foundation Human Rights Violation Incident Report Form

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Please include only one incident per form.

Email Address of person filling out form: *

Name of person filling out form: *

Phone Number of person filling out form:

Please include country code.

INCIDENT DETAILS

Please be as thorough as possible. Unless you click "I consent" in the last question, the names and exact location WILL NOT be shared publicly. Include a description of the perpetrator(s), and any other identifying factors, as well as exactly what was said or done by the perpetrator(s).

First and Last Name of person(s) affected (separate by commas) *

Date of Incident *

YYYY

Time of Incident

Time

Location of Incident *

Please provide city and country. If the neighborhood or address is available, please include that information as well.

Nature of Incident *

Physical assault or attack to person

Damage to property

Verbal abuse, harassment, or threats of harm to person and/or property (in person or phone)

Online abuse, harassment, threats of harm to person and/or property, or publishing of personal information including but not limited to home address, place of employment, telephone number, and other personal information that places an individual and their family and/or colleagues at risk for harm

Required

Detailed Description of Incident *

Was the incident reported to law enforcement? *

Yes

If yes, what law enforcement agency?

Please include contact details for the representative of the law enforcement agency.

If the incident was reported in media and/or community organization(s) please include the links here: *

I consent to the details of this incident being utilized for written communications to governments, reports, press statements, and other forms of communication by the Hindu American Foundation. *

I consent.

I prefer to keep this information private.

I am filling this form out on behalf of other individual(s).

Required

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