Edge Emergency Response Form

Welcome to the Edge Emergency Response Form. 

This form was created to provide accessible, urgent, and human rights-centered responses to cases involving individuals or organizations that need emergency interventions where one’s rights have been violated due to prejudice or bias against one’s sexual orientation, gender identity and/or expression, and sex characteristics (SOGIESC). Your response will help us get the information we need to support you to the best of our ability. 

We encourage you to provide as much detail as possible, noting that our efficient response is highly dependent on the existence of detailed, clear, and verifiable information. By submitting this form, you are contributing to the documentation and reporting of cases of human rights violations for evidence-based advocacy on SOGIESC rights. Your report will be responded to, documented, and anonymized for evidence-based advocacy on SOGIESC rights. 

Please note that TIERs works with the National Human Rights Commission (NHRC) to provide support and intervention for reported cases. While they are privy to all reports documented, your data is secure, and your report will not be used against you in any form. Your identity is protected at all times.

When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.

Is this a SOGIESC-Based Request/Report? *Please select an optionYesNo

Are you Applying as an Individual or an Organisation *Please select an optionIndividualOrganisation

Name of Organisation *

Organisation Email Address *

Location of Organisation *Include specific address, town, local government, state

Name of Contact Person *

Contact Person's Email Address *

Type of Request

Amount requiredPlease note that financial aid can either be direct or indirect. Direct financial support covers expenses like logistics for relocation. Indirect financial support is for payments made to third party like lawyers for legal fees, health facilities for medical bills etc.

Summary of the Emergency Situation/Project *Describe the incident or situation you require emergency support for. Include relevant details such as the date, location, time, and any individuals involved (if applicable).

Supporting DocumentsUpload all relevant supporting documents.

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Full name *As it appears on your ID

Preferred Name

PronounsShe/HerHe/HimThey/ThemIt/ItsEy/EmOther

Email Address *

Phone Number *

Age *

Location *Include specific address, town, local government, state

Gender *Please select an optionCis WomanCis ManTrans WomanTrans ManNonbinaryGenderqueerAgenderOther

Sexual Orientation *

SexPlease select an optionMaleFemaleIntersex

Employment Status *Please select an optionEmployedSelf-employedUnemployedStudentOther

Type of SOGIESC Violation *Select all that applyKitoBlackmailExtortionKidnapAssaultHarrassmentUnlawful arrestDiscrimination based on HIV statusCyberbullyingThreat to lifeForceful evictionOther

Perpetrator details *Select all that apply. State actors are agents and instititutions affiliated with the government, like the police, soldiers etc. Non-state actors are individuals and organisations not affiliated with the government.State actorsNon-state actorsOther

Date of Incident *

Location of Incident *

Type of Request *How do you want TIERs to support youPlease select an optionMedical supportPsychosocial/therapy supportRelocation supportFinancial supportLegal supportOther

Type of Financial Support Needed *Select all that applyWelfare supportLogistics supportMedical supportLegal supportOther

Summary of the emergency situation *Describe the incident or situation you require emergency support for. Include relevant details such as the date, location, time, and any individuals involved (if applicable).

Amount Required

Upload a Copy of Your NIN/ID *

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Referral 1 *Add your referral's information, including their name, email address, phone number, and organisational affiliation. Please note that your referrals have to be verifiable activists, community-based organisations or individuals.

Referral 2 *Add your referral's information, including their name, email address, phone number, and organisational affiliation. Please note that your referrals have to be verifiable activists, community-based organisations or individuals.

Supporting documents *Upload all relevant supporting documents.

Drag and Drop (or) Choose Files

Please note that TIERs works with the National Human Rights Commission (NHRC) to provide support and intervention for reported cases. Do you consent to the NHRC reaching out to you to validate your report and possibly provide the support you require? *Please select an optionYesNo

Please note that TIERs works with the National Human Rights Commission (NHRC) to provide support and intervention for reported cases. Do you consent to the NHRC reaching out to you to validate your report and possibly provide the support you require? *Please select an optionYesNo

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