Take Action Report incidents of rights violations or violence against LGBTI people Please note that all fields marked with an asterisk (*) are required. Your safety is our first priority. Therefore, your identity and any information that leads to your identification, whether as a reporter or as a victim of discrimination or violence, will not be shared with anyone. Please note that at the end of this form you will receive a code for submitting future updates. Please store this code safely. 1 Time of incident Make required fields actually required Approximate Time 0:00 1:00 2:00 3:00 4:00 5:00 6:00 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 Location of incident Select Province Alborz Ardabil Bushehr Chaharmahal and Bakhtiari East Azerbaijan Fars Gilan Golestan Hamedan Hormozgan Ilam Isfahan Kerman Kermanshah Khuzestan Kohgiluyeh and Boyer-Ahmad Kurdistan Lorestan Markazi Mazandaran North Khorasan Qazvin Qom Razavi Khorasan Semnan Sistan and Baluchestan South Khorasan Tehran West Azerbaijan Yazd Zanjan Select City Abadan, Khuzestan Abadeh, Fars Abarkuh, Yazd Abbar, Zanjan Abbasabad, Mazandaran Abdanan, Ilam Abhar, Zanjan Abyek, Qazvin Ahar, East Azerbaijan Ahram, Bushehr Ahvaz, Khuzestan Ajab Shir, East Azerbaijan Aleshtar, Lorestan Aliabad-e Katul, Golestan Aligudarz, Lorestan Alvand, Qazvin Amlash, Gilan Amol, Mazandaran Anar, Kerman Anbarabad, Kerman Andimeshk, Khuzestan Aq Qala, Golestan Aradan, Semnan Arak, Markazi Arakvaz-e Malekshahi, Ilam Aran Bidgol, Isfahan Ardabil, Ardabil Ardakan, Yazd Ardal, Chaharmahal and Bakhtiari Ardestan, Isfahan Arsanjan, Fars Arzuiyeh, Kerman Asadabad, Hamedan Asadiyeh, South Khorasan Ashkezar, Yazd Ashkhaneh, North Khorasan Ashtian, Markazi Astaneh-ye Ashrafiyeh, Gilan Astara, Gilan Azadshahr, Golestan Azarshahr, East Azerbaijan Azna, Lorestan Babol, Mazandaran Babolsar, Mazandaran Bafq, Yazd Baft, Kerman Bagh-e Malek, Khuzestan Bahar, Hamedan Bajestan, Razavi Khorasan Bam, Kerman Bandar Abbas, Hormozgan Bandar-e Anzali, Gilan Bandar-e Asaluyeh, Bushehr Bandar-e Bushehr, Bushehr Bandar-e Deylam, Bushehr Bandar-e Gaz, Golestan Bandar-e Genaveh, Bushehr Bandar-e Khamir, Hormozgan Bandar-e Lengeh, Hormozgan Bandar-e Mahshahr, Khuzestan Bandar-e Torkaman, Golestan Baneh, Kurdistan Bardaskan, Razavi Khorasan Bardsir, Kerman Basht, Kohgiluyeh and Boyer-Ahmad Bastak, Hormozgan Behbahan, Khuzestan Behshahr, Mazandaran Bijar, Kurdistan Bileh Savar, Ardabil Birjand, South Khorasan Bojnurd, North Khorasan Bonab, East Azerbaijan Borazjan, Bushehr Borujen, Chaharmahal and Bakhtiari Borujerd, Lorestan Boshruyeh, South Khorasan Bostanabad, East Azerbaijan Bozghan, Razavi Khorasan Buin Zahra, Qazvin Bukan, West Azerbaijan Bumahen, Tehran Chabahar, Sistan and Baluchestan Chadegan, Isfahan Chalus, Mazandaran Charam, Kohgiluyeh and Boyer-Ahmad Chelgard, Chaharmahal and Bakhtiari Chenaran, Razavi Khorasan Dalgan, Sistan and Baluchestan Damavand, Tehran Damghan, Semnan Darab, Fars Daran, Isfahan Darcheh, Isfahan Dargaz, Razavi Khorasan Darreh Shahr, Ilam Dehaqan, Isfahan Dehdasht, Kohgiluyeh and Boyer-Ahmad Dehgolan, Kurdistan Dehloran, Ilam Delijan, Markazi Deyr, Bushehr Dezful, Khuzestan Divandarreh, Kurdistan Do Gonbadan, Kohgiluyeh and Boyer-Ahmad Dorud, Lorestan Dowlatabad, Isfahan Dowlatabad, Razavi Khorasan Dust Mohammad Khan, Sistan and Baluchestan Eqlid, Fars Esfahan, Isfahan Esfarayen, North Khorasan Eshtehard, Alborz Eslamabad, Kerman Eslamabad-e Gharb, Kermanshah Eslamshahr, Tehran Estahban, Fars Evaz, Fars Eyvan, Ilam Fahraj, Kerman Falavarjan, Isfahan Famenin, Hamedan Farashband, Fars Fardis, Tehran Fariman, Razavi Khorasan Farmahin, Markazi Farsan, Chaharmahal and Bakhtiari Faruj, North Khorasan Faryab, Kerman Fasa, Fars Ferdows, South Khorasan Fereydun Kenar, Mazandaran Fereydunshahr, Isfahan Feyzabad, Razavi Khorasan Firuzabad, Fars Firuzkuh, Tehran Fuman, Gilan Galikesh, Golestan Galugah, Mazandaran Garmeh, North Khorasan Garmsar, Semnan Gavbandi, Hormozgan Gerash, Fars Germi, Ardabil Gilan-e Gharb, Kermanshah Givi, Ardabil Goldasht, Isfahan Golmeh, Ilam Golpayegan, Isfahan Gomishan, Golestan Gonabad, Razavi Khorasan Gonbad-e Kavus, Golestan Gorgan, Golestan Hadishahr, East Azerbaijan Haftkel, Khuzestan Hajjiabad, Fars Hajjiabad, South Khorasan Hajjiabad, Hormozgan Hamadan, Hamedan Harsin, Kermanshah Hashtgerd, Alborz Hashtpar, Gilan Hashtrud, East Azerbaijan Hendijan, Khuzestan Heris, East Azerbaijan Hoveyzeh, Khuzestan Ilam, Ilam Iranshahr, Sistan and Baluchestan Jahrom, Fars Jajarm, North Khorasan Jam, Bushehr Jask, Hormozgan Javanrud, Kermanshah Jiroft, Kerman Joghtay, Razavi Khorasan Jolfa, East Azerbaijan Juybar, Mazandaran Kabudarahang, Hamedan Kahnuj, Kerman Kahrizak, Tehran Kalaleh, Golestan Kalat-e Naderi, Razavi Khorasan Kaleybar, East Azerbaijan Kamalshahr, Alborz Kamyaran, Kurdistan Kangan, Bushehr Karaj, Alborz Kashan, Isfahan Kashmar, Razavi Khorasan Kavar, Fars Kazerun, Fars Kelishad va Sudarjan, Isfahan Kerend-e Gharb, Kermanshah Kerman, Kerman Kermanshah, Kermanshah Khak-e Ali, Qazvin Khalilabad, Razavi Khorasan Khalkhal, Ardabil Khash, Sistan and Baluchestan Kherameh, Fars Khomarlu, East Azerbaijan Khomeyn, Markazi Khomeyni Shahr, Isfahan Khondab, Markazi Khonj, Fars Khorramabad, Lorestan Khorramdarreh, Zanjan Khorramshahr, Khuzestan Khowrasgan, Isfahan Khowrmuj, Bushehr Khowy, West Azerbaijan Khur, Isfahan Khvaf, Razavi Khorasan Khvansar, Isfahan Komijan, Markazi Konarak, Sistan and Baluchestan Kord Kuy, Golestan Kuhbanan, Kerman Kuhdasht, Lorestan Lahijan, Gilan Lali, Khuzestan Lamerd, Fars Langarud, Gilan Likak, Kohgiluyeh and Boyer-Ahmad Lordegan, Chaharmahal and Bakhtiari Madan, Khuzestan Mahabad, West Azerbaijan Mahallat, Markazi Mahdasht, Tehran Mahdishahr, Semnan Mahmudabad, Mazandaran Mahneshan, Zanjan Maku, West Azerbaijan Malard, Tehran Malayer, Hamedan Malekan, East Azerbaijan Mamuniyeh, Markazi Manujan, Kerman Maragheh, East Azerbaijan Marand, East Azerbaijan Maraveh Tappeh, Golestan Marivan, Kurdistan Marvdasht, Fars Masal, Gilan Mashhad, Razavi Khorasan Masiri, Fars Masjed Soleyman, Khuzestan Mayamey, Semnan Mehran, Ilam Mehriz, Yazd Meshgin Shahr, Ardabil Meybod, Yazd Miandoab, West Azerbaijan Mianeh, East Azerbaijan Minab, Hormozgan Minudasht, Golestan Mobarakeh, Isfahan Mohammad Shahr, Alborz Mohammadabad, Kerman Mohr, Fars Mollasani, Khuzestan Nahavand, Hamedan Nain, Isfahan Najafabad, Isfahan Namin, Ardabil Naqadeh, West Azerbaijan Narmashir, Kerman Nasim Shahr, Tehran Natanz, Isfahan Nazarabad, Alborz Nehbandan, South Khorasan Neka, Mazandaran Neqab, Razavi Khorasan Neyriz, Fars Neyshabur, Razavi Khorasan Nikshahr, Sistan and Baluchestan Nir, Ardabil Nowshahr, Mazandaran Nur, Mazandaran Nurabad, Lorestan Nurabad, Fars Omidiyeh, Khuzestan Orumiyeh, West Azerbaijan Oshnaviyeh, West Azerbaijan Osku, East Azerbaijan Pain-e Bazar-e Rudbar, Gilan Pakdasht, Tehran Parsabad, Ardabil Paveh, Kermanshah Piranshahr, West Azerbaijan Pishva, Tehran Pol-e Sefid, Mazandaran Poldasht, West Azerbaijan Poldokhtar, Lorestan Qaem Shahr, Mazandaran Qaen, South Khorasan Qahderijan, Isfahan Qaleh Ganj, Kerman Qaleh-ye Khvajeh, Khuzestan Qarah Aghaj, East Azerbaijan Qarah Zia od Din, West Azerbaijan Qarchak, Tehran Qasr-e Shirin, Kermanshah Qazvin, Qazvin Qeshm, Hormozgan Qir, Fars Qom, Qom Qorveh, Kurdistan Quchan, Razavi Khorasan Rabor, Kerman Rafsanjan, Kerman Ramhormoz, Khuzestan Ramian, Golestan Ramsar, Mazandaran Ramshir, Khuzestan Rasak, Sistan and Baluchestan Rasht, Gilan Ravansar, Kermanshah Ravar, Kerman Razan, Hamedan Rey, Tehran Rezvanshahr, Gilan Robat Karim, Tehran Roshtkhvar, Razavi Khorasan Rudan, Hormozgan Rudsar, Gilan Saadat Shahr, Fars Sabzevar, Razavi Khorasan Safashahr, Fars Sahneh, Kermanshah Salmas, West Azerbaijan Sanandaj, Kurdistan Saqqez, Kurdistan Sarab, East Azerbaijan Sarab-e Dureh, Lorestan Sarableh, Ilam Sarakhs, Razavi Khorasan Saravan, Sistan and Baluchestan Sarayan, South Khorasan Sarbaz, Sistan and Baluchestan Sarbisheh, South Khorasan Sardasht, Hormozgan Sardasht, West Azerbaijan Sareyn, Ardabil Sari, Mazandaran Sarpol-e Zahab, Kermanshah Sarta, Mazandaran Sarvabad, Kurdistan Sarvestan, Fars Saveh, Markazi Semirom, Isfahan Semnan, Semnan Sepidan, Fars Seyah Cheshmeh, West Azerbaijan Shabestar, East Azerbaijan Shadegan, Khuzestan Shaft, Gilan Shahin Dezh, West Azerbaijan Shahin Shahr, Isfahan Shahr-e Babak, Kerman Shahr-e Herat, Yazd Shahr-e Kord, Chaharmahal and Bakhtiari Shahr-e Qadim-e Lar, Fars Shahr-e Qods, Tehran Shahrak-e Bakharz, Razavi Khorasan Shahreza, Isfahan Shahriar, Tehran Shahrud, Semnan Shalamzar, Chaharmahal and Bakhtiari Shazand, Markazi Sheyban, Khuzestan Shiraz, Fars Shirvan, North Khorasan Showt, West Azerbaijan Shush, Khuzestan Shushtar, Khuzestan Siahkal, Gilan Sirik, Hormozgan Sirjan, Kerman Sisakht, Kohgiluyeh and Boyer-Ahmad Soltanabad, Razavi Khorasan Sonqor, Kermanshah Sorkheh, Semnan Sowmeeh Sara, Gilan Surak, Mazandaran Suran, Sistan and Baluchestan Surian, Fars Susangerd, Khuzestan Tabas, South Khorasan Tabriz, East Azerbaijan Tafresh, Markazi Taft, Yazd Tajrish, Tehran Takab, West Azerbaijan Takestan, Qazvin Taleqan, Alborz Taybad, Razavi Khorasan Tazehabad, Kermanshah Tehran, Tehran Tiran, Isfahan Tonekabon, Mazandaran Torbat-e Heydariyeh, Razavi Khorasan Torbat-e Jam, Razavi Khorasan Torqabeh, Razavi Khorasan Tuyserkan, Hamedan Varamin, Tehran Varazqan, East Azerbaijan Yasuj, Kohgiluyeh and Boyer-Ahmad Yazd, Yazd Zabol, Sistan and Baluchestan Zaboli, Sistan and Baluchestan Zahedan, Sistan and Baluchestan Zanjan, Zanjan Zarand, Kerman Zarrin Shahr, Isfahan Zarrinabad, Zanjan Zehak, Sistan and Baluchestan Add New City Optional: Use my current location Area or village Geocoordinates Place of incident Place of incident Home Public place including streets School Workplace Government Office Healthcare establishment Other Are you reporting an incident related to yourself, or other person(s)? Myself Other person(s) Publicationname Pseudonym 2 About You Details of the person or persons whose rights have been violated Name Age Age 0-14 14-18 19-25 26-30 31-35 36-40 Over 40 Gender Gender Woman Man Non-binary Trans woman Trans man Other Sexual Orientation Sexual Orientation Unknown Gay Lesbian Bisexual Heterosexual Pansexual Other Do you belong to an ethnic minority? Does this person belong to an ethnic minority? Does this person belong to an ethnic minority? Not an ethnic minority Kurd Gilak Turk Turkmen Lor Arab Baloch Non-Iranian Migrant Other Religion Religion Shia Sunni Christian Jewish Bahai Zoroastrian Atheist Other What's your relationship with this person? What's your relationship with this person? Partner Immediate family member Relative Friend Classmate Colleague Not related Other Others Affected If in addition to you, this incident has happened to other(s) as well, please add their details If this incident affects more than one person, please add the additional person's details Add Another Person 3 How did you find out about this incident? I was an eyewitness I heard about it from a person or persons whose rights have been violated I was informed by a person or persons other than those whose rights have been violated How did the incident you are reporting occur? Who was the person(s), or institution that violated the right? Have you been harmed as result of this incident? If so, how? Was the person(s) you are reporting about harmed as result of this incident? If so, how? Did anyone try to help you? Did anyone try to help the person(s) you are reporting about? Yes No I don't know Please describe what kind of help you received. Please describe what kind of help the person(s) received. Have you contacted the police or sought legal recourse? Did the person(s) you are reporting about contact the police or seek legal recourse? Yes No I don't know What was their response? Are you still at risk? Is the person(s) you are reporting about still at risk? Yes No I don't know Not Applicable Are you currently safe and in a secure place? Is the person(s) you are reporting about currently safe and in a secure place? Yes No I don't know Not Applicable Would you like to receive legal or psychological counsel? Would the person(s) you are reporting about like to receive legal or psychological counsel? Yes No I don't know Not Applicable We may need to contact you to follow up on the incident or provide counseling. Please enter your WhatsApp number or Signal number, or an email address. Optional: Upload images or videos to document your report. Maximum File Size: 256MB. Supported formats: .jpg .gif .png .pdf .mov and .mp4 If your file is larger than 256MB, please provide us with your contact information so we can contact you directly about securely sending your attachments to us. Add Another Media File Some required items are not completed correctly. Please review and make sure all of the questions marked with an asterisk (*) are filled correctly before re-submitting. Upload in progress. Please wait... Thank you for taking the time to report this incident. Your follow-up and updates code is %s. Use this code if you need to submit updates about this incident and make sure to store it safely. Your incident report was submitted successfully. If you require legal or psychological counseling, please contact the following Telegram account: @Rainbow247 Return to Home Page Your Incident Report could not be submitted at the moment due to a connection error. However, it is saved and will be submitted automatically when possible. Your Incident Report was NOT submitted successfully. An error occurred when trying to save your report. Person Number delete this person Name Age Age 0-14 14-18 19-25 26-30 31-35 36-40 Over 40 Gender Gender Woman Man Non-binary Trans woman Trans man Other Sexual Orientation Sexual Orientation Unknown Gay Lesbian Bisexual Heterosexual Pansexual Other Does this person belong to an ethnic minority? Not an ethnic minority Kurd Gilak Turk Turkmen Lor Arab Baloch Non-Iranian Migrant Other Religion Shia Sunni Christian Jewish Bahai Zoroastrian Atheist Other What's your relationship with this person? What's your relationship with this person? Partner Immediate family member Relative Friend Classmate Colleague Not related Other
