HATE-CRIME.NET

Report an Incident
 

Using this form, you can report all types of hate crime and related incidents, even those from years ago.  It is easy and takes only a short while.  And it is very important.

Please fill out all portions of this form, especially the items in red.

PLEASE TELL US...
About You:
What's your name?
Your city/town:
State/province:
Your phone number:
Your email address:
Please provide an email address where it is safe to contact you.
How were you involved:
Please identify if "other":
IS THIS AN UPDATE? If this is an update to an incident already reported, enter the original TRACKING NUMBER, if known: 
 
 
About the Victim(s):
How many victims TOTAL were directly affected by this incident? 
About Victim #1: NOTE: If there is more than one victim, complete the following based on a primary victim. You will report on the other victims later. If the primary target was property, such as a building, enter information about the owner of the property.
Victim's age:
Name:
Address:
City:
State/province:
Country
ZIP or Postal Code: If you don't know the postal code, please enter 00000
Telephone:
Email:
Gender:
Sexual orientation:
Ethnicity:
Please specify ethnicity if you selected "other":

About Other Victim(s):

 Skip ahead to the Incident section if there was only one victim.
How old were the other victims?

To choose multiple answers, hold CTRL key down while selecting
How many other victims were... 
Male?
Female?
Other/unknown?
Race/Ethnicity:

To choose multiple answers, hold CTRL key down while selecting
Sexual orientation(s): 

To choose multiple answers, hold CTRL key down while selecting

About the Incident:

Date of incident: 
If you are reporting an incident prior to 1997, please be sure to give the correct year in your description of what happened, below.
Address/location where the incident happened:
If you are reporting an online incident, you may enter your address or the Web address, chat room location, or the name of your Internet Service Provider (e.g., AOL).
City/town where incident happened:
State/province:
ZIP or Postal Code: If you don't know the postal code, please enter 00000
Country:
Type of Location:
If you picked "other" in the last question, please describe location type here:
Pick the offenses that were involved:

Hold CTRL key down while selecting to choose multiple offenses

Items in (... ) are examples only
Please specify if "other":
Briefly describe what happened:

Provide a complete picture of what happened and why. Be sure to describe any markings, words, symbols, offensive gestures, or other actions that were used that might reveal the perpetrator's bias and motive.  Include as much detail as possible.
Were there any injuries?
Medical Attention?
  For the next 3 questions, please give a short explanation of how the victim suffered in the following areas:
Physical effects:
Financial effects:
Emotional effects:
 
DEFINITIONS: "Bias" is hatred, hostility, or negative attitudes toward a person, institution, or group based on their race, sexual orientation, disability, religion, national origin, or gender.  Indicators of bias include comments, words, graffiti, recurring incidents, cruelty, or brutality.  Incidents that are motivated --at least partly -- because of bias, are considered expressions of hatred or prejudice.  Criminal acts that are motivated at least partly because of bias, are generally termed "hate crimes."  The term "perpetrator" refers to a person who was involved in causing the incident.
Next, please tell us what you believe motivated the perpetrator(s) to do this.
 
Motive(s):

Hold CTRL key down while selecting to choose multiple motives
Please specify if "other":
What factors, such as what was said or done, indicate that this incident was motivated by hate/bias?

About the Perpetrator(s):

In this section you will tell us about the people who caused this hate incident.  Please answer the following questions even if there was only one.
How many people directly participated in causing this incident?
How many of the perpetrators were... 
Male?
Female?
Other/unknown? 
Race/Ethnicity:

Hold CTRL key down while selecting to choose multiple answers
Please specify the ethnicity if you selected "other":
Please give approximate ages, if known.

To choose multiple answers, hold CTRL key down while selecting
Sexual orientation(s):

Hold CTRL key down while selecting to choose multiple answers

Perpetrator(s) part of a "hate group"?  Yes No Not sure
Describe as much as you can about the perpetrator(s).
How were they related to the victim(s)?

Hold CTRL key down while selecting to choose multiple answers
Please specify relationship to victim(s) if you selected "other":

About This Report:

 Was this incident reported to the police or law enforcement? Yes No Unknown
To which agencies was the report made? (Local police, sheriff, state police, etc.)
 If police were not contacted, why not?
 If police were contacted, how did they respond?
 To whom else was this incident reported?
 Please tell us how the reports (above) were handled, if given?
 Was this incident part of an ongoing series of incidents between the same victim(s) and perpetrator(s)? YesNoUnknown

How To Handle Your Report:

Why are you reporting this incident?
What types of help do you need?
If more information is needed, how can you be reached? It is OK to contact me by...e-mailphonemail
If you prefer that you not be contacted, is there someone else that can be contacted? Please indicate how to reach them:

Permission to Release: HATE-CRIME.NET will  summarize the details in this report into an anonymous narrative that is used publicly to create awareness about hate crimes.   Is this acceptable? YesNo
     
If you are completely comfortable with the information you have provided in this form and it is complete to the best of your knowledge, please click the SUBMIT button below.

    

 

Thank you.  Please press SUBMIT only once. Don't press the Submit button more than once. It may take a few moments to transfer your information, so please be patient.  You will see an acknowledgement.

 

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