Please explain the discriminatory incident providing as many details as possible*

Who is involved? Please list the name(s) of the individual(s), age/age group (i.e u-10s / senior) and National Team(s)/Club(s) involved.*

Fixture at which incident took place (if applicable)

Were the match officials made aware of the incident? (if applicable)

Did the match officials take any action in response to the incident? (If applicable)

Were there any other witnesses to the incident? (if applicable)

Have you contacted anyone else to inform them about the incident? (e.g. Area Association, Police)

Is there any additional information you would like to add?

Can we keep in contact? If you are prepared for the FAW to contact you directly and if required pass on your details to the UEFA Integrity team or Police authorities, please do so otherwise, you will remain totally anonymous.*

Please Select:

Yes, I am happy to provide my name and details, which I understand may be passed on to the relevant FAW Area Association, UEFA/FIFA or Police authorities.No, I would like to remain anonymous and have given all the information that I can.

(If yes)