The vision of CAIR-FL is to be a leading advocate for social justice and mutual understanding.

CAIR's mission is to enhance a general understanding of Islam, encourage dialogue, protect civil liberties, empower American Muslims and build coalitions that promote justice and mutual understanding.

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Name*

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Home Number*

Gender*

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Ethnicity*

Name of Attorney or Representative

Date of Most Recent Incident*

Representative's phone

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Offender Information

Name of Business or Organization

Address*

Contact Person*

Contact's Position*

Contact's Phone*

Type of Business*

Business Email*

Business Telephone*

Business Fax

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Incident Details

Type of Abuse

- Select Value -BullyingCBPCitizenshipDenial of Religious AccommodationDenial of Service or AccessDestruction/Damage/VandalismEmploymentFBIHarassmentICEIslamophobic PropagandaMultiple Federal Government AgenciesPhysical ViolenceState or Local PoliceTSAUSCISZoningOther

Location

- Select Value -Air/Bus/Train TerminalBank/Savings & LoanCommercial Office BuildingDepartment/Discount StoreDoctor’s Office/Hospital/PharmacyGovernment/Public BuildingHighway/Road/Alley/StreetHotel/MotelJail/PrisonMosque/Islamic CenterParking Lot/GarageResidence/HomeRestaurantSchool/CollegeService/Gas StationShopping MallUnknownOther (Islamic)Other

Triggering Factor

- Select Value -Ethnic AttireEthnicity/National Org.HajjHeadscarf/HijabIslamic BeardIslamic Holiday/EidKufi/TurbanLanguageMuslim BusinessNameOther Muslim ActivityOther Muslim InstitutionPolitical OpinionPlace of WorshipPrayerPrayer (Friday)Quran or Other Islamic LiteratureRamadanOther

Provide a detailed description of the incident. Include dates, witnesses, and any evidence of religious discrimination.

Summary of Incident(s)*

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