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Report a Crime


Reports of LGBT hate crimes and violence help KCAVP staff track hate crimes and bias-related incidents. This information will only be used to collect data in order to find out what is going on in the community unless you tell us that you want to be contacted for further assistance. You may choose to remain anonymous and do not have to provide us with information that would reveal your identity.

Complete this form if you have been the victim or have personal knowledge of LGBT hate related harassment, property damage, or violence.


All information you provide is STRICTLY CONFIDENTIAL and will not be shared with anyone else including law enforcement. If the primary target of the attack was an institution or organization, enter that information.

Note: if there was one more than victim, complete and submit this online form for each victim.

General Information

How were you involved?

If other, please specify:

How were you referred to KCAVP?

Please provide additional information for the question above::


Victim Information

Victim's name:

Were you the victim?

Yes No

Victim's city:

Victim's county:

Victim's state:

Victim's age:

Victim's gender identity:

If other, please specify:

Victim's sexual orientation:

If other, please specify:

Victim's race:

If other, please specify:

Extent of injuries:

Please describe the injuries:

Medical attention reqiured:


Incident Information

Date of incident:

Time of incident:

Location of incident:

Street Address of incident:

Site type:

If other, please specify:

Bias motive:

Anti LGBT/Heterosexist

HIV related

Anti-transgender

Disability

Economic

Religious

Sexist

Other

If other, please specify:

In your own words, please tell us what happened, in as much detail as possible:

Have you reported this to law enforcement?

Yes No

If yes, which law enforcement agency?


Offender Information

Number of offenders:

Was a vehicle used?

Yes No

Please describe make, model, color and license plate if known:

Relationship of the offender(s) to the victim:

If other, please specify:

Describe the offender(s) (take into consideration age, sex, ethnicity, height, build, tattoos, and clothing):


Your Contact Information

Would you like us to contact you about this incident?

Yes No

If you would like to be contacted by a KCAVP Victim Advocate, please provide your contact information below

Your name:

Phone number:

Email address:

Any other comments: