Report Antisemitism
Date of incident
*
-
Month
-
Day
Year
Date
What was the nature of the incident? (check all that apply)
*
Antisemetic
Anti-Israel
Bullying
Digital Post
Verbal
Physical
Graffiti
Anti-Zionist
Other
Back
Next
Location of incident (please be as specific as possible)
*
Were there any witnesses other than yourself?
*
Yes
No
Please provide witness information below (optional)
Was a police report filed?
*
Yes
No
Back
Next
If you have any documentary evidence (e.g. photo, video, license plate number, screenshot, etc.), please list and/or upload in the fields below.
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Can you describe the offending individual(s)?
*
Yes
No
I did not see the person
Please provide a description of the individual(s) including as many details as you can.
*
Please provide a chronological account of what occurred
*
Back
Next
Your Information
Name
*
First Name
Last Name
Email
*
Confirmation Email
example@example.com
Mobile Phone Number
*
What is your preferred method of communication? (check all that apply)
*
Call
Text
Email
I prefer not to be contacted
Other
SUBMIT
Should be Empty: