Intake Form
The Boston Human Rights Commission created this Anonymous Incident Reporting Form. The option of anonymity allows people to safely submit an incident report, providing a platform to speak up on incidents of hate and discrimination in the City of Boston. Regardless of the seriousness of the incident, it can be reported with confidence that your identity and contact information will be protected if you choose. This form is for intake purposes only and does not indicate that the Boston Human Rights Commission has accepted this report as a complaint. Our staff will be in touch with you to follow up on your submission.

Please note that some of these questions require a response*  
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First Name (optional)
Last Name (optional)
Your Full Address including City, State and Zip Code (optional)
What is your racial/ethnic background? *
Required
What is your gender identity? 
 *
Required
How did you hear about our office?
Date of incident *
MM
/
DD
/
YYYY
Location / address of the incident: *
Incident details (Check all that apply): *
Required
What do you believe played a role in the incident? (Check all that apply): *
Required
Discrimination Type 
 *
Required
Description of incident (tell us what happened): *
Were the police involved? *
Have you contacted any other City, state, or federal agency about this? *
Depending on the incident, the Human Rights Commission may work with the Boston Police Department to further investigate. Is this OK with you? *
Is there other information you want us to know? (optional)
 Would you like us to contact you? *
Phone Number or Email (optional)
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