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Name/nickname *
E-mail *
Your age at the time of the violation *
Your sexual orientation

Your sex/gender
You are -

Your occupation
When did the case occur? *
Case description *
Why do you think the violation is connected to LGBT issues? *
Type of violation you encountered:

Perpetrator (persons who have caused damage):

How did this situation impact your life?
Are there witnesses of the violation / other victims?

Have you turned with this case to:

If you have appealed to state bodies (police, prosecutors office, court), please, write the full name of this body
Results of your appeal, if you did appeal:
Do you have any copies of the documents or any other evidence confirming the fact of the violation?

What exact evidence you have?
How can we make this case public?

Are there any other details, which you would like to report to us in this case?
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