CAIR-Kansas Report an Incident

If you or someone you know has experienced religious discrimination or has been contacted by law enforcement, please report the incident to us using the form below.
Please fill in your information:
Incident date and time:*

MonthDayYear
Your Full Name*

Mr/Ms/MrsFirst NameLast Name
Filer Name

Mr/Ms/MrsFirst NameLast Name
E-mail*
Gender*

MaleFemale
Home Phone
Mobile Number
Work Phone
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Ethnic Background
Religion
Please fill in offending party's information:
Full Name*

Mr/Ms/MrsFirst NameLast Name
Gender*

MaleFemale
Home Phone
Mobile Number
Work Phone
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Location of Incident*
Please provide a detailed description of the incident:*
The media regularly contacts CAIR for information on cases.
Do you authorize CAIR to give the media your contact information?*

YesNo
Would you like to subscribe to CAIR's email list?*

YesNo
Should be Empty: