The Coalition for Tolerance and Justice

Incident Report

The Coalition for Tolerance and Justice Sussex County, Delaware

Please fill out those blanks that are appropriate for the incident you are reporting

and return with any supporting documents to:

P.O. Box 410

Lewes, DE 19958

Phone Number: 302.644.3949

Email:

CONTACT INFORMATION
Contact (Name of Person Reporting Incident)		Are you an eyewitness?			Date of Report
		¨ Yes ¨ No
Contact Street Address		City		State		Zip

Contact Phone	Contact Fax		Contact Email

Additional Contact Information (employment, hours available, etc.)

INCIDENT BASIC INFORMATION
Incident Location (Business and/or Place Name)	Date of Incident		Time of Incident

Incident Street Address	City	State		Zip

Name(s) of Principal Victim(s)

Brief Summary of Incident (When, Who, What, Why, How) Attach Additional Pages as Needed

INCIDENT FOLLOWUP INFORMATION
Was this incident formally reported? (To Police, Agency administration, etc.)		Date of that formal report	Who placed the formal report?
¨ Yes (to: ______________________________) ¨ No
What media organizations have been notified or have covered this event?		Date(s) of media notice or coverage	Who contacted the media?

Can we forward your report to authorities?	Can we provide your report to media?	Can we post information from your report?
¨ Yes ¨ No	¨ Yes ¨ No	¨ Yes ¨ No
What are your hopes or expectations of the Coalition for Tolerance and Justice in response? Attach Additional Pages as Needed

Signature of Report Contact	Second Signature (Witness to Report) (if applicable or desired)

Helpful Resources in case of:

Employment Discrimination	Federal: Equal Employment Opportunity Commission (EEOC)at the following phone numbers: 1-202-663-4814 (Hotline) or 1-800-669-4000. Visit their website for more information about your workplace rights - www.eeoc.gov
Public Accommodation Discrimination	State: http://statehumanrelations.delaware.gov/contact.shtml http://www.state.de.us/sos/hr/discrimination.shtml
Housing Discrimination	Federal: Department of Housing and Urban Development (HUD) at the following phone numbers: 1-800-669-9777 or file a complaint online and if you believe there is a pattern or practice of discrimination, contact the Housing and Civil Enforcement Section at 1-202-514-4713.
Housing Discrimination	State: http://www.state.de.us/sos/hr/contact_info.shtml http://www.state.de.us/sos/hr/discrimination.shtml
Education Discrimination	Federal: U.S. Department of Education, Office for Civil Rights at the following phone number: 1-800-421-3481 or send an e-mail to www.ed.gov/ocr/
Education Discrimination	State: Delaware Department of Education: http://www.doe.state.de.us/ P.O. Box 1402, John G. Townsend Building, Dover, Delaware 19903-1402 PHONE: (302) 739-4601, FAX: (302) 739-4654, EMAIL: dedoe@doe.k12.de.us

Concerning Hate Crimes

Some incidents of intolerance and injustice constitute hate crimes. If you believe you have been the victim of a hate crime, many advise the following:

Report the crime to your local police station immediately. Ask that the incident be treated as a hate crime. Follow up with investigators.
Document the incident. Write down exactly what was said and/or done by the offender. Save evidence. Take photographs.
Act quickly. Each incident must be dealt with when it happens, not when convenient.
Decide on the appropriate action to be taken. Consider issuing a statement from community leaders, holding a news conference, organizing a protest, meeting with officials, or starting a letter writing campaign.
Mobilize community support. Contact the Coalition for Tolerance and Justice, your own community of faith, or another supportive organization.
Stay on top of the situation.
Announce results. When the incident is resolved, make an announcement to the same people and organizations originally contacted.