Contact Information:

*First Name



*Last Name



*Your Email



*Your Phone



*Address







Demographic Information:

*Gender

Male Female Other

*Age

Under 18 18-25 26-35 36-50 50+

*Religion

Sikh Other

*Ethnicity

South Asian White Other





What Happened?

*What kind of incident: choose all that apply



*When did this happen:



*Where did this happen:





*Describe the location:

On the street Home (on your property) Business or work Public transport (plane, bus, taxi, ferry, terminal or port) School University Online Gurdwara or place of worship Other

Why do you think you were targeted: choose all that apply

Turban or Patka (Sikh covering) Beard Chooni (Punjabi scarf) Traditional clothing (e.g. salwar suit, sari, kurta pajama) Language Skin Color Accent Other

*Please Describe The Incident:

Please provide as many details as possible including who was with you, the surroundings, how you were dressed and approached.



*Were there any witnesses?

Yes No

*Did you report this to the police?

Yes No

Looking for legal assistance from the Sikh Coalition instead?

The Sikh Coalition provides legal assistance to Sikhs who have faced discrimination or bias based upon their religious beliefs or Sikh identity. We provide each of our clients with the highest quality of legal service. We therefore selectively accept a limited number of cases based on our ability to provide this level of service. We do not accept every potential legal matter. If you require legal assistance from the Sikh Coalition and your case falls within these parameters, please fill out our legal request assistance form here and our legal team will aim to contact you within 1-3 business days.

The information provided will never be sold or rented to a third party. We may share this information with organizations that research or advocate against hate crime. No identifying information (such as name, phone, email, or street address) about yourself will be shared with any third parties without your consent.

I do not want this report to be shared with other organizations that research or advocate against hate crimes.