Statewide Transgender Discrimination and Harassment Survey

Format for printing
Make your story count! If you have experienced discrimination or harassment in Indiana based on your gender identity or expression, please let us know about it by completing this survey. Our elected officials need to know that discrimination and harassment against transgender people is occurring in Indiana and laws are needed to protect transgender people.

All items marked with * are required.


If you do not want to include your name, please at least include your initials.

Date when discrimination or harassment started.

Date when discrimination or harassment ended.
Is the discrimination or harassment ongoing?

For the purposes of followup, please include at least one method to contact you.
*Can we share your name and contact information with legislators?:



Please tell us how we can use your identifying information.

Tell us where the discrimination or harassment occurred. Please include the city.

Please describe the incident in detail.

Was this incident resolved? If so, please describe.

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