United States Attorney’s Office
Southern District of New York
Civil Rights Unit
Civil Rights Complaint Form
The Civil Rights Unit of the United States Attorney’s Office is charged with enforcing the federal civil rights laws within
the Southern District of New York, which includes Bronx, Dutchess, New York, Orange, Putnam, Rockland, Sullivan, and
Westchester counties. We therefore welcome information from the public that brings to our attention possible violations of our
Nation’s civil rights laws.
Person Filing complaint
Person/Entity you are filing complaint about:
:
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Name
Name of Person or Entity
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Address
Address
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Address (Line 2)
Address (Line 2)
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City, State
Zip
City, State
Zip
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_____________________ ________________________
County
Phone
County
Phone
Nature of Alleged Civil Rights Violation:
[ ] Disability Rights
[ ] Fair Housing
[ ] Voting Rights
[ ] Educational Opportunities
[ ] Law Enforcement Misconduct [ ] Other: _______________
[ ] Employment Discrimination
[ ] Prisoner/Institutional Rights
Please clearly describe the violation of the civil rights laws that you would like to bring to our attention.
Include as much information as possible, including the date, place, nature of incident, and contact
information for any witnesses (do not send original documents):
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