Felon Re-Enfranchisement Legal Intake Form

Use this form only if you have had problems registering to vote because of a criminal record. If you need legal assistance with any other matter, please download the form “Request for Legal Assistance” here.

If you need immediate assistance with a voting rights problem, please call:

1-866-OUR-VOTE

Name: *

Address: *

Phone Number: *

Telephone number where I can be reached:

Please briefly describe the problem that you had registering to vote: *

Currently

If off parole, when did you come off?:

If released from prison, when were you released?:

If "Other" please describe:

I tried to register to vote by:

Visiting a Board of Elections office

Mail

Filling out a voter registration form elsewhere

I was told:

To bring in a certificate or other documentation showing that I am off parole

That I was unable to register because of my felony conviction

That my application to register was rejected

That they would not give me a registration form

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New York Civil Liberties Union
125 Broad Street, New York, NY 10004 Phone 212-607-3300 Fax 212-607-3318 and 212-607-3329