Racism Report form (E)

    Racist discrimination in the region of Basel

    Discrimination and violence exist in many forms and there are different ways
    to take action against them!
    This form offers you the possibility to report discrimination and to receive professional
    advice from the office «Stopp Rassismus» (stop racism).

    Tick the appropriate boxes:

    I’d like to

    I was

    When? Date, ev. time of incident:

    Where?

    What?

    short description of the incident:

    First name:

    Family name:

    Phone:

    e-Mail:

    Place:

    Date:

    Your info is treated confidentially, used in case of consultation.