Lincolnshire FA Discrimination Report Form

As part of Lincolnshire FA's commitment to creating safe and inclusive football environments, we have created this form for anyone involved in football to report discrimination should they witness it.


We would like to take this opportunity to thank you for taking the time to fill this form in. We are sorry that either you have been a victim or have witnessed discrimination or discriminatory behaviour. If you need any support a member of the discipline team will contact with details of Sporting Chance, the FA's charity partner in supporting victims of discrimination.


Please complete the form, providing as much detail as you can. This information will then be passed to the members of the discipline team who will open an investigation into the report submitted. They will contact you to confirm they've received your report and may ask for further information should they need it as part of their investigation.

 
 
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If known, please provide the name of the alleged offender. Alternatively please include the alleged offender's number and/or a short description of the individual.

 

Please select the alleged offender's role in the game.

 

Please select which club you believe the alleged offender to be involved with.

 

Please provide as much detail as you can of the incident. For any discriminatory language used, please include the alleged words used in full. We understand this may be difficult, but it will be really useful for the discipline teams investigation.

 

Please Include your name

 

Please include your contact information including your email address as we may ask you for further information regarding your statement.

 

Please tick if the game was abandoned

 

Please tick if you're prepared to attend a Hearing.

 

Please tick if you're happy for your statement to be disclosed to the alleged offender. Your statement would only be disclosed at the point of charge, at which point the alleged offender would be see you report and your name.