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 report an incidentreport an incident and receive advice I was directly affected by the incidentwitnessing the incident When? Date, ev. time of incident: Where? institution (e.g. shop, bank)public space (e.g. at park)administration (e.g. tax offices)job search, job marketschool, work placeapartment search, tenancyprivatepolice What? discrimination, disadvantagemobbingphysical attackproperty damageinsultsfalse accusationrefusal of services short description of the incident: First name: Family name: Phone: e-Mail: Place: Date: Your info is treated confidentially, used in case of consultation. Δ