Letter Request Form

October 9, 2025

Thank you for your interest in receiving a letter of support from Assemblymember Edward Gibbs. Please complete the form below and someone from the team will reach out to you. This form is for letters of support related to incarcerated individuals, if you need a letter for something else, please email your request to gibbse@nyassembly.gov.

Title

First Name

Middle Initial

Last Name

Suffix

Phone Number

Confirm Email

Address

Address Line 2

Apt Number

City

State

Zip

1. Who is the letter for? Please include full legal name and DIN number if applicable.

2. What type of letter are you requesting?

Parole

Clemency

Pardon

Sentencing

Bail

Other (please specify)

3. When do you need the letter by?

4. Please provide a brief summary of the charges, sentencing, and prior criminal history for this individual.

5. If this person is or was incarcerated, please list out the programs and certifications completed while incarcerated.

6. If you/they have been released, please list any educational or other accomplishments since being released that you would like to be highlighted. If not yet released, write N/A.

7. Please provide some information on your/their life outside, either before or after, including family, school/work, community involvement, etc.

8. If there are any mitigating factors to your/their arrest that you believe should be considered, please provide some information on those below. If not, write N/A.

9. Do you have any references or additional letters of support? If so, who?

10. Is there anything else you would like to share with us or believe we should know when considering the request or preparing the letter?

User Name