LayoutLocation of the incident (specific city and area of the city) *Is the incident still ongoing or already in the past? *Please select oneYesNoWhat type of incident are you experiencing? *Please describe the type of rights violation(s) and or abuse(s) you experienced (e.g., harassment, discrimination, violence, unlawful arrest etc.)
Description of the Incident *Please provide a brief description of the rights violation(s) and or abuse(s) you experienced (What happened? Who was involved? Were there any witnesses?):Provide Evidences

Evidence and Documentation

Do you have any evidence or documentation of the rights violation(s) and or abuse(s)? *Please select oneYesNo (e.g., photos, videos, messages, witnesses or medical documents)?
Describe the evidence you have *Would you like to take legal action, or use this as a way to advocate for the rights of LGBTQI persons? *Please select oneYes, I want to take legal action.No, I prefer you anonymously use my documentation to advocate for the rights of LGBTQI persons.

Personal Information

LayoutName of person reporting the incident *Reporter’s phone number: *Survivor's Gender Identity *Trans WomanTrans ManCis WomanCis ManNon-BinaryOtherAge *Name of the Survivor * Reporter’s e-mail address: (optional)Survivor’s sexual orientation *LesbianGayBisexualPansexualAsexuaQueerHeterosexualOccupation *

Additional Information (Optional)

Are there anything else you would like us to know about the incident?
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