Report an Incident

This is a placeholder where the progress elements will display. Be careful no to remove this wrapper.

1. Incident Details

*What happened?

Other

Date of Incident

Incident Description

I believe I was discriminated against because of my actual or perceived:

How can we help?

This was something that...

Have you contacted any law enforcement agency regarding this matter?

Which agency?

Please be advised that ADL is neither a legal services agency nor a law enforcement agency. All potential criminal incidents should also be reported to local, state, or federal authorities, as appropriate. If you are fearful of reporting to police for any reason, please consider referring to this list of community support agencies/organizations.

Upload a file?

YesNo

Photo, video, or other file from incident

Upload another file?

YesNo

Photo, video, or other file from incident

Upload another file?

YesNo

Photo, video, or other file from incident

Upload another file?

YesNo

Photo, video, or other file from incident

Upload another file?

YesNo

Photo, video, or other file from incident

User Geolocation

Address & Map

Street Address

City/State

Zip / Postal Code

Country

Report an Incident

This is a placeholder where the progress elements will display. Be careful no to remove this wrapper.

2. Incident Location

Where did this happen?

College/University

What is the name of the college/University?

Department/School in which the incident took place College

Your college Role

StudentFacultyAdministratorJewish Professional on CampusParentAlumniOther

If you answered 'other', what is your affiliation with the college/University?

How did you learn about this incident?

Why did you decide to report this incident to ADL?

Did you report this incident to college/University?

YesNo

If yes, who did you communicate with?

If yes, what was the response?

If yes, have you been in touch with the Director of DEI?

PreviouslyRelating to this incidentPreviously & relating to this incidentNo

Are you affiliated with a campus organization that is involved with this incident?

YesNo

If yes, what is the name of the organization?

School Incident

What is the name of the school?

Did the incident occur on school grounds?

YesNo

How are you affiliated with the school?

StudentParentFacultyAdministratorAlumniOther

If you answered 'other' how did you learn about this incident?

Why did you decide to report this incident to ADL?

Did you report this incident to school officials?

YesNo

If answered yes, what was the response?

If answered yes, who did you communicate with?

Do you give ADL permission to contact the school officials?

YesNo

Synagogue

Name of Synagogue

City of Synagogue

State of Synagogue

If the synagogue is affiliated with any movement, denomination or organization, please detail below.

Do you give ADL permission to share the incident details provided in this report with the indicated movement, denomination or organization?

YesNo

Do you give ADL permission to contact the synagogue?

YesNo

Do you hold any official role in the synagogue?

ClergyCongregantEducatorLay LeadershipProfessional/Administrator

What is your official title?

Is this an ongoing issue?

YesNo

Date of first incident

On which platform/s did the incident/s occur?

DiscordEmail FacebookInstagramPinterestTikTokTwitchX/TwitterYoutubeNot on Social MediaZoomOther

Where you saw/experienced the hate

Have you reported the incident to the platform(s) on which the incident occurred?

Yes

No

What is the case number?

Who is the target of the harassment?

Name or group

What is the target’s screen name or handle?

What kind of content or activity are you reporting? (Choose all that apply)

One piece of objectionable content (a single hateful meme)A body of objectionable content (i.e. a Neo Nazi twitter account) Ongoing negative activity directed at me (more than three emails, tweets, posts, responses) Ongoing activity directed at someone else (more than three emails, tweets, posts, responses)Ongoing activity directed at me and someone else (more than three emails, tweets, posts, responses)Something else

Please explain

Do you know the perpetrator?

Yes

No

Name

Screen Name

What is your relationship to the perpetrator?

Has the perpetrator given you any indication about their motivation? If so, what? Please provide relevant details.

Please include relevant links/web addresses to the offensive posts.

Link/web address

Add another link/web address?

Yes

Add link/web address

Add another link/web address?

Yes

Add link/web address

Add another link/web address?

Yes

Add link/web address

Add another link/web address?

Yes

Add link/web address

Please report the incident/s to the platform(s) if you have not done so yet. You are your own best advocate and often a platform requires you to report the issue through their system regardless of any steps we take. Please review our Cyber Safety Action Guide and guide to Managing Cyberhate and Harassment.

Country

Please select the country in which incident took place

State

Please select the state in which incident took place.

City

Please select the city in which incident took place

Report an Incident

This is a placeholder where the progress elements will display. Be careful no to remove this wrapper.

3. Contact Information

Your Pronouns

Your First Name

Your Last Name

Your Email Address

Your Phone Number

Is there any method and time to reach out to you, if necessary?

Please check this box if you prefer not to be contact by ADL regarding this incident.

Your Zip Code/Postal Code

Optional: I agree that for purposes of investigation, ADL may use my name when making inquiries, including inquiries directly to the person or entity who allegedly committed the act(s).

Please check this box if you are a minor.

I agree to ADL's terms and conditions, as articulated here.

reCAPTCHA helps prevent automated form spam.

The submit button will be disabled until you complete the CAPTCHA.

Contact Information