| First Name: |
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| Last Name: |
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| Email: |
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| Address: |
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| Phone #: |
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| Because of my Christian faith and lifestyle, I have been the victim of: |
Insults and/or defamation
Descrimination at work
Intimidation or harassment
Physical assault
Censorship of religious speech
Other
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| Please tell us your story of anti-Christian discrimination, bigotry, and/or defamation. (400 words or less) |
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| Yes, I give permission for CADC - at its discretion - to make this story public |
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| Thank you for submitting your story. Due to the limited resources of the CADC, we make no guarantees that your report will be acted on in any particular manner. The staff of CADC will make recommendations, and if further information is needed you will be contacted. |
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