File a Report with CAIR-Texas

File a Report with CAIR-Texas

Your information will remain confidential with CAIR-Texas Austin/DFW
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Ethnic Background
Your Religion
Gender

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Incident Information

My complaint is Against the Following
The Complaint is Against
Please list the agency, employer, business, school or other offending party.
Person or Individual Name
Email
Phone Number
Date(s) of Incident
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Incident Summary
Briefly describe your incident
Do you authorize CAIR-DFW to give the media your contact information

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Agreement
I, the individual submitting this online form, understand that submission of this application is not a guarantee of assistance. I understand that I may be required to submit additional information and I agree to do so in a timely manner. I understand that failure to cooperate with information requests or other assistance-related requests may result in my application for assistance being denied. I understand that submitting this form does not establish attorney–client privilege.
Agreement

Yes, I agree
Please verify that you are human*
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Incident Information