(202) 244-2990

Report an Incident

Please fill out this form clearly, describe the incident with enough information so we can better understand your complaint. The information you provide will remain confidential during the investigation and verification of the incident.

ADC does not provide legal assistance in the following matters: divorce/family related cases, contract/business related cases, and criminal cases.

If you have been contacted by the FBI for an interview or appointment, we can help. Please call our office right away at (202) 244-2990.

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Incident Report/Discrimination Claim

STATEMENT OF CONFIDENTIALITY: The contents of this intake form and any attachments are confidential and are intended solely for the American-Arab Anti-Discrimination Committee.

Personal Information

First Name*

Last/Family Name*

Email

Phone Number*

Address

City

State

ZIP Code

Incident Information

Category of Discrimination*

Type of Discrimination

Date of incident(s)
(approx. date or dates)*

Address or location of incident(s)*

Involved party name(s)

Will you be willing to talk to the media?*

Which is your preferred language?*

Do you have an attorney for this matter?*

Please describe the incident(s)*

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