Reporting form

All information is voluntary

Affected person

Who has been affected by discrimination?
meanother personmy child

Gender
femalemaletransgenderintergenderother

Age

School

Class

Type of school
primary schoolsecondary schoolschool for children with spechial needsthrough evening classesgymnasium/grammar schoolother

Who is reporting the case of discrimination?
affected persona friend of the affected persona family member of the affected personparents of the affected personother

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Details about the case of discrimination

When did it happen?

Description of the situation

Where did the discrimitaion take place?
after-school centerWay to school/way homeschoolother

In which federal state of germany did the case of discrimination take place?
BerlinBrandenburgall other federal states

Who was responsible for the discrimination?
after-school care assistantteachersocial workerheadmasterstudentsother

Were there any witnesses?
yesno

Information about possible interventions

What was the ground for discrimination?
ageethic backgroundskin colordisabilitygenderreligionyour valuessexual orientationstatus

other

consulting desire

If yes, we need your contact data

last name

first name

telefon number

email

How did you find out about ADAS?
by mouth-to-mouth recommendationsschoolwebsitesocial networks other:

We would like to thank you for your report. We use the report for our documentation and delete the personal data after 4 years.
If you have any questions feel free to contact us!
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