Human rights Username *Email *PhoneSexual OrientationGayBisexualLesbianQueerHeterosexualOthersGenderMaleFemaleMale-FemaleFemale-MaleNon-BinaryOthersPlease provide a brief description of the challenge, situation, or crisis that you encountered. (This should include a description of any antecedent or barrier that you may have experienced)Address where the incident took placeState where the incident took placeDate of IncidenceNames, contact, and social media handle of (perpetrators)….(If available)In cases of emergency psychosocial, medical, or legal referral is needed, please do indicate below.PsychosocialMedicalLegalPlease provide pdf, jpeg, or any supporting document to aid your referralChoose FileNo file chosenDelete uploaded fileSubmit