Violation Report Form TIERs Human Rights Violations Report Form Email Address *First Name *Last NamePreferred NamePronoun *Age *Gender Identity *Sexual Orientation *Phone Number *Type of Violation *select from the listSexual Harrasement/AbuseKitoPhysical AbuseDiscriminationKidnappingHate SpeechBatteryAssaultThreat to LifeRobberyRapeInvasion of PrivacyConversion of PracticeUnlawful ArrestBlackmailForceful EvictionDefamationExtortionWrongful DismissalOutingOthersDate of Incident *Type of Incident *Location of Incident *Summary of Incident *Summary of Support Needed from TIERs *Send Message
