Report Antisemitic Incident

Contact Information

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Email*

Nature of the Incident

Incident Definitions

Expression means written or verbal communication by groups or individuals, including public, elected, or religious figures. It includes publicly or privately directed letters, phone conversations, articles, speeches, email, or other internet communication.

Harassment means verbal threat or written threat directed at a person or institution, or physical assaults on an individual

Vandalism means an attack on property like arson, destruction, or defacement.

Check All That Apply*

ExpressionHarassmentVandalismOther

Date of Incident*

Location of Incident*

What is your relationship to the person who experienced the incident?*

Description of Incident*

Did you report the incident to the police?*

YesNo

Did you report the incident to someone at the location where it happened (i.e., school, workplace, social media platform)?*

YesNo

If you reported, who did you report the incident to? What was the result or action taken?

Did you take photos or screenshots?*

YesNo

If you took photos or screenshots, please upload the file(s).

Additional Message

Incident Reporting Form

Contact Information

Nature of the Incident