New York City Antisemitism / Anti-Zionist Discrimination Intake Form **

(Confidential – For Legal Review Only)

STEP 1 – CONTACT INFORMATION

Is this complaint related to your workplace, housing, school, or public accommodations*?






* – mandatory field

STEP 2 – IDENTITY INFORMATION (protected-class validation)

Are you a Jewish Zionist*?


* – mandatory field

STEP 3 – INCIDENT SUMMARY

* – mandatory field

STEP 4 – PRIOR ACTIONS TAKEN

Have you filed a complaint with the state and/or city Human Rights agencies?*


Are you currently represented by a lawyer or any other organization?*


* – mandatory field

STEP 5 – CONSENT

Consent Given*:

By submitting this form, I understand that:

  • Submitting information does not create an attorney-client relationship.
  • Zachor Legal Institute will review the information and may contact me for follow-up.
  • I consent to Zachor’s internal use of this information for legal analysis and case review.

* – mandatory field




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