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?
I don't want to involve the police
You plan to
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.
English, Welsh, Scottish, Northern Irish or British
Gypsy or Irish Traveller
Polish, Romanian, Eastern European
Any other White background
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed or Multiple ethnic background
Any other Black, African or Caribbean background
Any other Asian background
Any other ethnic group