{{ $tenant_name }}
Report date : {{ $date }}
| Date: | {{ $date }} |
| Created by: | {{ $created_by }} |
| Tenant full name: | {{ $tenant_name }} |
| Case Priority: | {{ $priority }} |
| Case Status: | {{ $status }} |
| Current Address: | {{ $current_address }} |
| Tenant Email : | {{ $email }} |
| Tenant Phone number: | {{ $phone_number }} |
| Client’s LGBT+ Rights Organization name worked with: | {{ $organization_name_worked_with }} |
| Client’s LGBT+ Rights Organization address worked with: | {{ $organization_address_worked_with }} |
| Client’s Position Held At Organization: | {{ $organization_position }} |
| Clients Date of birth: | {{ $date_of_birth }} |
| Clients Gender: | {{ $gender }} |
| Emergency contact person name: | {{ $person_name_to_contact_incase_of_emergency }} |
| Emergency contact person email: | {{ $person_email_to_contact_incase_of_emergency }} |
| Emergency contact person phone number: | {{ $person_phone_to_contact_incase_of_emergency }} |
| Details of LGBT+ rights activities involved in including organizations and dates worked for and the duration: | {{ $activities_done }} |
| What happened? (Details of the threats/incidents received and from whom including dates): | {{ $what_happened }} |
| When did it happen: | {{ $when_it_happened }} |
| Where did it happen: | {{ $where_it_happened }} |
| Why did it happen: | {{ $why_it_happened }} |
| What specific support does the victim need?: | {{ $support_needed }} |
| What can we do as UMSC?: | {{ $what_can_we_do }} |
| Please include a tentative, detailed budget for emergency support:: | {{ $budget }} |
| What is your sustainability plan for the support you may receive?: | {{ $sustainability_plan }} |
| Secondary person contact name : | {{ $secondary_person_name }} |
| Secondary person contact email: | {{ $secondary_person_email }} |
| Secondary person contact phone number: | {{ $secondary_person_phone }} |
| Enter evidence information: | {{ $written_evidence }} |
| Is there any other information that you would like us to know?: | {{ $any_other_information }} |
| Comment on case: | {{ $comment_on_case }} |
| Photo evidence 2: | |