Staten Island NAACP Legal Redress Committee Intake Form

Please note: Applications will not be processed unless all questions are fully completed and include a one-page summary of the alleged complaint. Incomplete submissions will not be investigated.

The Staten Island NAACP Legal Redress Committee is responsible for reviewing and investigating incidents reported to the Branch. The Committee assists residents and employees in Staten Island, NY, who are seeking relief from discriminatory acts.

Comprised of dedicated volunteers, the Legal Redress Committee carefully evaluates each complaint for evidence of racial, employment, education, and housing discrimination. The Committee does not provide legal advice or legal representation. Instead, it serves as a liaison—connecting individuals in need with reputable legal and community-based resources.

If you require immediate legal assistance, please contact a local attorney. You may search for an attorney through the Metropolitan Black Bar Association, Lawyer Legion, or the Richmond County Bar Association.
If you are the victim of a crime, please contact your local New York City Police Department precinct.
If your issue occurred outside of Staten Island, please contact your local NAACP branch: naacp.org/finf-local-unit

Your Full Name*

First NameLast Name

Are you a member of the NAACP?*

YesNo

If you are a member, please provide membership number

Email Address*

example@example.com

Phone Number

Please enter a valid phone number.

Preferred method of contact

EmailPhone

Type of Discrimination Experienced*

Date of Incident*

Date

Location of Incident (address, city, or place)*

Please describe the incident in detail*

Name(s) of person(s) or organization(s) accused (if known)

Do you have any supporting documents or evidence? If yes, please upload them here.

Have you filed a complaint with any governmental agency?*

YesNo

Which government agency did you file a complaint with?*

Enter "N/A" if you answered "No" to the previous question.

Have you filed a grievance with your Union?

YesNoNot Applicable

Please provide the name of your Union and your union representative.

Have you retained an attorney regarding this case?

YesNo

Please provide the name for attorney.

What is your attorney's email address?

example@example.com

Release of Liability
I affirm that the statements that I have made above are accurate and true to the best of my knowledge and belief. I hereby request the assistance of the Staten Island NAACP in seeking a remedy to the situation described above.

I hereby authorize the officers and the Legal Redress Committee of the Staten Island NAACP to have access to information and documents which are relevant to my claim of discrimination described above. I understand that the NAACP is not a law firm and cannot provide me with legal advice or legal representation. Although some of its members and volunteers are lawyers, they represent the NAACP and not me personally.

I understand that once a referral has been made to a volunteer, community agency, or private attorney, the Staten Island NAACP WILL NOT BE RESPONSIBLE for handling this matter. In fact, I further understand that by signing this document, I am agreeing to HOLD Staten Island NAACP harmless for any and all damages arising as a result of my case being mishandled, negligently handled, or improperly handled in any way.

Release of Liability*

Section 704 (a) of the Civil Rights Act of 1964

Section 704 (a) of the Civil Rights Act of 1964, (as amended), Section 4 (d) of the Age Discrimination in Employment Act of 1967, (as amended), and various other civil rights laws make it an unlawful employment practice for an employer; employment agency; or labor organization to discriminate against employees, applicants for employment, member or applicant for membership, because the employee, member or applicant has opposed an unlawful employment practice, made a charge, testified, assisted, or participated in any manner in an investigation, proceeding or hearing. All legal claims have deadlines. For some civil rights violations, you may be required to file a notice or pursue options with a government agency before you can file a lawsuit in court. If you do not comply with time deadlines or notice requirements, you could be legally prevented from pursuing your claim in court. Contacting the NAACP for assistance does not stop these deadlines or eliminate the need to file notices. If you have an urgent need or must meet a deadline, contact a private attorney, your local public defender, or your state’s bar association.

Acknowledgement of the Civil Rights Act of 1964*

DO NOT WAIT for a response from the Staten Island NAACP.

To file a discrimination complaint in New York, you can submit a complaint online, by mail, or in person to the New York State Division of Human Rights (NYSDHR) (within 1 year) or the NYC Commission on Human Rights (NYCCHR) (within 1-3 years). For employment, you can file with the U.S. Equal Employment Opportunity Commission (EEOC) within 300 days.

Key Filing Options & Agencies

New York State Division of Human Rights (NYSDHR): Handles complaints regarding employment, housing, public accommodations, and education. File online at dhr.ny.gov or via mail/in-person at regional offices.
NYC Commission on Human Rights (NYCCHR): Handles discrimination in NYC. Complaints must be filed within one year for general discrimination, or three years for gender-based harassment.
U.S. Equal Employment Opportunity Commission (EEOC): For workplace discrimination (employers with 15+ employees). You must file with the EEOC before initiating a federal lawsuit.
NY Attorney General (Civil Rights Bureau): Investigates patterns of discrimination; complaint forms can be submitted online.
Education: The Office of the New York State Attorney General promotes equal justice under the law and enforces all New Yorkers’ civil rights, including the right to go to school without experiencing discrimination.

Completing this form does not constitute filing an official complaint with a legal authority. At this time, the Staten Island NAACP is ONLY seeking information to assist you concerning this complaint.

Please upload your supporting documents above or mail this information and copies of your supporting documents in an envelope marked “Confidential” to: Staten Island NAACP, Legal Redress Committee, P.O. Box 140164, Staten Island, NY 10314.