Report an Incident @ CAIR-Chicago


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If you or someone you know has been a victim of an anti-Muslim hate crime, or an act of discrimination, kindly fill out this form to have your case reviewed by the CAIR-Chicago's civil rights department. Please note that your identity will remain confidential.


Your Information:

Incident Date:	Ex: 09/17/1976
First Name:		Last Name:
Home Phone:		Work Phone:
Mobile Number:		Fax:
Email Address:		Sex:
Title:		Affiliation:
Street Address:		City:
State:		Zip Code:
Ethnic Background:		Religion:
*Filer Name:**	* Please enter if different from above

The media Regularly contacts CAIR-Chicago for information on cases. Do you authorize CAIR-Chicago to give the media your contact information?

Please provide a detailed description of the incident below. Include date, time, witnesses, and any evidence of religious discrimination:

Please check if you are a CAIR member


Offending Party's Information:

First Name:		Last Name:
Home Phone:		Work Phone:
Mobile Number:		Fax:
Email Address:		Sex:
Title		Affiliation:
Street Address:		City:
State:		Zip Code: