NYPD Protest Response Form

Submitter Information

First Name *

Last Name *

Street Address

City/Town

State

Zip Code

Phone Number *

Email *

Race/ethnicity (Optional)

Race/ethnicity (Optional) Other

Interaction Details

Were you physically present to witness or experience any alleged misconduct by any NYPD officer(s) during the protest? *

Yes

How were you involved? *

I was directly involved in interactions with NYPD officer(s)

I witnessed others’ interactions with NYPD officer(s)

Additional Interactions

Did you witness or experience other alleged misconduct by NYPD during the protest? *

Yes

Select the types of alleged misconduct you witnessed or experienced *

Biased policing

False arrest

Use of offensive language or discourtesy

Lack of mask/personal protective equipment

Obstructed shield/badge

Unjustified stop and/or frisk

Other

Other type of alleged misconduct *

Please include as much detail as possible, including what occurred and the officer(s) involved

Have you made a complaint regarding the incident(s) you describe above to any other agency (e.g., Civilian Complaint Review Board, City Commission on Human Rights)? *

Yes

Which agency? *

Have you filed any legal action against NYC or the NYPD arising out of the information you provided? *

Yes

Please provide the court and case number *

Is there any other information relevant to our investigation that you would like to share with us?

Submit up to 5 supporting photographs of the incidents you describe above. Please note that each file must be smaller than 10 MB and combined file size of all attachments may not exceed 50 MB. To share video files, go to the “Links to Video” section.

How many files would you like to upload? *

File Attachment 1

File Upload *

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png bmp psd txt pdf doc docx ppt pptx xls xlsx.

File Name

File Ownership *

I am the owner of this file

I do not know the owner of this file

I know the owner of this file

File Ownership I know the owner of this file

File Attachment 2

File Upload *

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png bmp psd txt pdf doc docx ppt pptx xls xlsx.

File Name

File Ownership *

I am the owner of this file

I do not know the owner of this file

I know the owner of this file

File Ownership I know the owner of this file

File Attachment 3

File Upload *

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png bmp psd txt pdf doc docx ppt pptx xls xlsx.

File Name

File Ownership *

I am the owner of this file

I do not know the owner of this file

I know the owner of this file

File Ownership I know the owner of this file

File Attachment 4

File Upload *

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png bmp psd txt pdf doc docx ppt pptx xls xlsx.

File Name

File Ownership *

I am the owner of this file

I do not know the owner of this file

I know the owner of this file

File Ownership I know the owner of this file

File Attachment 5

File Upload *

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png bmp psd txt pdf doc docx ppt pptx xls xlsx.

File Name

File Ownership *

I am the owner of this file

I do not know the owner of this file

I know the owner of this file

File Ownership I know the owner of this file

Submit up to 5 supporting videos of the incidents you describe above. To share video files, please upload to a third-party video site -- such as YouTube, Vimeo, Twitter, Instagram, or Facebook -- and provide the direct link to the content and a brief description of the nature of the video below.

How many videos would you like to link to? *

Video Link 1

Full link to video *

Description of content *

Video Ownership *

I am the owner of this video

I do not know the owner of this video

I know the owner of this video

Video Ownership I know the owner of this video

Video Link 2

Full link to video *

Description of content *

Video Ownership *

I am the owner of this video

I do not know the owner of this video

I know the owner of this video

Video Ownership I know the owner of this video

Video Link 3

Full link to video *

Description of content *

Video Ownership *

I am the owner of this video

I do not know the owner of this video

I know the owner of this video

Video Ownership I know the owner of this video

Video Link 4

Full link to video *

Description of content *

Video Ownership *

I am the owner of this video

I do not know the owner of this video

I know the owner of this video

Video Ownership I know the owner of this video

Video Link 5

Full link to video *

Description of content *

Video Ownership *

I am the owner of this video

I do not know the owner of this video

I know the owner of this video

Video Ownership I know the owner of this video

Signature

Date

Witness / Personally Involved

In providing the Attorney General's Office this information, I understand that:

Note: All boxes much be checked before submission *

The Attorney General is not my private attorney but represents the public in enforcing laws. My providing this information does not mean the Attorney General has initiated a lawsuit or proceeding on my behalf.

The Attorney General cannot give me legal advice or represent me in court. If I have questions concerning my legal rights or responsibilities, I should contact a private attorney.

The Attorney General may use my statement regarding my interactions with the NYPD during recent protests and any other documents, photographs, videos and/or other information I provided related to this investigation in a public document, including in a legal proceeding or public report or statement.

I understand that if I wish to file a complaint with the New York City Civilian Complaint Review Board, I have to reach out to that agency directly.

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