Department of Corrections and Community Supervision

Office of Victim Assistance - Request for Victim Notification Form

Notification Information

Fields marked with an asterisk (*) are required.

I WOULD LIKE TO: (check ALL that apply) notified of an offender's release from a New York state-level Correctional facility. notified of NYS Parole Board interviews with an offender, and the results of those interviews. (Note that this right only applies to crime victims and their families.)
..provide or update a VICTIM IMPACT STATEMENT to the Board of Parole. (This right only applies to crime victims and their immediate family. If you select this option, you will be provided with more information about impact statements at a later date.)

Inmate Information:

Please provide as much information as possible. The District Attorney's Office in the county of conviction can help with this.

I understand that any information I give to the Parole Board will not be shared with the inmate convicted of the crime.
I will notify the Department of Corrections and Community Supervision's Office of Victim Assistance of any change of address. I understand failure to do so is likely to result in missed communication.