Protest Reimbursement Form

The Vermont chapters of the NAACP are coordinating the payment of citations and other fees associated with local racial justice protesting efforts. If you wish to submit your citation to be considered for payment, please fill out the form below. If approved, the NAACP will pay your citation directly with the State / Town / City in which you received the citation OR you can choose to have a check sent to you directly.

The NAACP supports local racial justice organizing efforts, and will reimburse citations incurred by those that are working nonviolently to dismantle systemic racism. If there are citations that are not in line with that criteria, we may choose to reject your request.

The NAACP volunteer team will process your request as quickly as possible. Please allow at least 48 hours before contacting us.

Question Title

* 1. Contact Information
(please include address if you would like us to mail you a check)

Name *

Pronouns *

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address *

Phone Number

Question Title

* 2. Please upload a photo or screenshot with details of your citation or fee to be paid.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 3. Please give a brief description of the situation in which you received this citation. This will help us analyze what's happening in the state.

Date

City or town

What was happening/what were you doing?

Protest Reimbursement Form

Question Title

* 1. Contact Information (please include address if you would like us to mail you a check)

Question Title

* 2. Please upload a photo or screenshot with details of your citation or fee to be paid.

Question Title

* 3. Please give a brief description of the situation in which you received this citation. This will help us analyze what's happening in the state.

Question Title

* 4. Any other comments or information you want to share?

* 1. Contact Information
(please include address if you would like us to mail you a check)