LGBTQ+ Community Member Interactions with Law Enforcement in the Des Moines Area
This form is still under construction. If you provide contact information, a member of the Des Moines LGBTQ Advisory Council may follow up with you.

DISCLAIMER
The following form is intended to collect information regarding interactions with a member(s) of law enforcement that impacted LGBTQ+ community members in Des Moines and the surrounding areas. You can share as much or as little identifying information as you prefer. The goal is to use the information collected to influence the creation and implementation of City policy to make Des Moines a more inclusive city.

If you encounter a trigger or mental health issue when completing this form, please feel free to stop and return to the form later. If you are experiencing an acute mental health issue, please stop this form. Some helpful resources may be the national Suicide Hotline at 1-800-273-8255, Transgender folks can also call the Trans Lifeline at 877-565-8860 or the Crisis Text Line, if you text HOME to 741741.

Every attempt will be made to keep the information you have provided as confidential, but we cannot guarantee complete confidentiality. We will do everything in our power to ensure this information is not passed on to immigration enforcement (like ICE). The answers you provide will be stored by the Iowa Queer Communities of Color Coalition. Information you provide may be provided to the Des Moines LGBTQ Advisory Council, The Civil and Human Rights Division of the City of Des Moines, the Civil and Human Rights Commission, or members of the City Council with as much identifying information removed as possible.

This survey is not a formal complaint. To file a complaint about the Des Moines Police Department, you can go to: https://icrc.iowa.gov/file-complaint or https://www.dsm.city/departments/police-division/general/office_of_professional_standards.php.

To file a complaint about an interaction outside of the City of Des Moines, please contact the Iowa Civil Rights Commission: https://icrc.iowa.gov/file-complaint
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Do you identify as a member of the LGBTQ+ community?
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Name (optional)
Email address (optional)
Do you live or work in Des Moines? Select all that apply.
Gender identity (check all that apply)
Race (select all the apply)
Ethnicity
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Pronouns (select all that apply)
Age
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When did the interaction take place?
MM
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DD
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YYYY
To the best of your knowledge, what time did the interaction take place?
Time
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Where did the interaction take place?
Describe the interaction with as much detail as you can. What happened before, during, and after the incident?
If the interaction was negative, did you file a formal complaint about this incident or interaction with a government agency or other official authority? *
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If you answered yes to the previous question, to what organization did you report this incident or interaction to? What was the outcome?
If you did not file a formal complaint after a negative interaction, could you please share why?
Are there witnesses to the interaction and if so, may we contact you for further information about them?
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What physical or emotional impacts did you experience as a result of the interaction? How long have the impacts lasted? Are they ongoing? Be as specific as you can.
Were any arrests, citations, or warnings issued? If so, what were they?
Do you have any video or photos of the interaction, and if so, may we contact you to learn more?
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