上報種族歧視事件 Report Hate Crime and Discrimination Incidents

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近期，華裔和亞裔由於新冠疫情遭受了無端指責和種族歧視。PCDC希望記錄這些事件，并向政府統一匯報並尋求協助。請記住，只有更多人上報此類事件，我們才能得到更多關注，更多幫助，并且改變現狀。無論你遭遇了，或是別人遭遇了，語言，網絡，或是身體上的攻擊，都請填寫此表。謝謝。
如果你有任何問題，請致電PCDC：215-922-2156；電子郵箱：info@chinatown-pcdc.org；微信號：chinatown-pcdc
（同時，如果您因新冠病毒而受到威脅，騷擾或毆打和指責，請立即致電911報案。）
Recently, Chinese and Asian communities have been suffering from unfounded blame and discrimination due to COVID-19. PCDC would like to record these incidents and report to the government in order to seek support. Only when we have more people to report these terrible incidents, can we get more attention, more support, and then change the situation. Please fill out this form if you or you know people have suffered from verbal, internet, or physical violence. Thank you.
If you have any questions, please call PCDC at 215-922-2156, email: info@chinatown-pcdc.org; WeChat: chinatown-pcdc
（At the same time, if you have been intimidated, harassed, or assaulted and blamed for COVID-19, please call 911 immediately.)

歧視事件是什麽時候發生的？（如果你不確定，可以估計大概日期）When did the incident happen? (If you are not sure, you can estimate) *

YYYY

歧視事件在哪裏發生的？（比如家裏，街上，商場裏，請盡量具體並提供郵編）Where did the incident happen? (Please be as specific as possible and provide ZIP code) *

歧視事件的類型？（選擇所有適用答案）Type of Discrimination (Select all that apply) *

語言，比如駡人 Verbal Harassment, e.g. yelling at you

身體暴力，比如毆打 Physical Assault, e.g. beating you

網絡暴力 Online Bullying, e.g. posting racist content

躲避 Shunning

工作場所的歧視 Workplace Discrimination

Other:

Required

遭到COVID-19歧視的疑似原因（選擇所有適用答案） Suspect Reason for COVID-19 Discrimination (Select all that apply) *

民族/種族 Race/Ethnicity

性別 Gender

語言 Language

宗教 Religion

口罩或著裝 Face Mask or Clothing

Other:

Required

請簡單描述發生了什麽（如果事件發生在網上，請提供網絡鏈接） Please describe what happened （please provide weblink if it's online） *

你有沒有視頻或圖片？如有，請通過電子郵件傳送給我們: info@chinatown-pcdc.org。Do you have pictures and videos? If so, please send them to us through email: info@chinatown-pcdc.org.

Yes

Clear selection

請留下姓名以便我們跟進 Please leave your name for followup purpose.

請留下聯係方式以便我們跟進（電話，郵箱或微信） Please leave your contact information for followup purpose. (Phone number, email address, and/or WeChat)

你是否希望我們幫你將此事件上報費城人際關係委員會（這是市政府處理歧視事件的部門）? Would you like us to report this incident to the Philadelphia Commission on Human Relations, which deal with hate crimes and discrimination incidents?

是的，請上報 Yes

不，不要上報 No

Clear selection

你是否同意我们在社交网络上匿名分享你的故事？这样可以引起更多人关注和讨论这个问题。Do you mind us sharing your story anonymously on our social media platform? It will raise public awareness and help us address this problem.

同意 I give PCDC permission to share my story anonymously.

不同意 I don't want PCDC to share my story.

Clear selection

Submit

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