Ottawa Islamophobic Incident Survey Oct-Dec 2023
Please let us know if you have experienced any Islamophobia recently in light of the current situation in Palestine.

The information provided in this form is confidential and will only be used for tracking purposes to keep our community safe. 

The form is currently being monitored by AMA admin and President. If you have any questions or concerns please do not hesitate to contact
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Approximate date of the incident *
Have you reported this to any authorities? *
Please tell us more about the incident (what happened, where, who was involved, etc.) *
Would you like to be contacted to further discuss the incident and be invited to speak about it? *
If you selected "Yes" in the previous questions, please enter your email / number below. Otherwise, please enter, -N/A-. *
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