Media Incident Report Form

Contact Information

Type of portrayal of Arab Americans, Arabs, or Muslims in the media:*

Please select all that apply:*

Do you have a copy/tape?

Please use the following space (attach files below, if necessary) to describe the incident and its context in detail, and for any additional comments and information you would like to convey:

Have you reported this incident to any other organization or person?*

Submit
 
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