Have you witnessed or been a victim of a race or religious hate incident? By reporting it, you're helping us to make a change.
Date of incident (dd/mm/yy)
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Have you reported this incident to the Police?
Do you want someone to contact you offering more support, sign-posting and guidance?

Optional - if you'd like to tell us about yourself then please complete the following, your information will not be shared with any other organisation or agency unless you give specific consent.