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BiasHELP
tracks hate crimes and bias-related incidents that occur throughout
the United States. This helps us to better understand these incidents
and effectively design programs to assist victims and prevent hate crimes
from occurring.
Complete
this form if:
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You have been the victim of hate-related harassment,
property damage or violence.
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You have personal knowledge of hate-related harassment,
property damage or violence.
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*REQUIRED*
You
are:
If other, please specify:
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You
may remain anonymous and do not have to give us any information that
would reveal your identity. If, however, you would like more information
about hate crimes or require our assistance in some way, please complete
the following so we can contact you:
The
information you send to YouthWEB
is STRICTLY CONFIDENTIAL
and will not be shared with anyone else.
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INFORMATION
ABOUT THE INCIDENT
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*REQUIRED*
Date
of incident:
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*REQUIRED*
Location:
If other, please specify:
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*REQUIRED*
Nature
of the incident:
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Please
tell us more about the victim, or if you are
the victim, please tell us more about yourself.
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Victim's
age
City
State:
Gender Identity:
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Did
the victim suffer physical injuries?
If yes, please describe:
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*REQUIRED*
Was
the offender acting alone or part of a group?
Alone
Group
Unsure
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*REQUIRED*
Please
tell us in your own words what happened?
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Was
this incident reported to anyone?
Yes
No
If yes, please select who:
If
the incident was reported to another person
or party, please specify who:
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| This
website is monitored periodically during weekdays. While we may be able
to provide you with information, referrals and assistance, we cannot guarantee
you an IMMEDIATE response, though we do promise to get back to you as
quickly as possible. |
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Would you like us to contact you about this incident?
Yes
No
If
you request to be contacted, please make sure
your contact info is completed *HERE
on this form*
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