Terms you can choose
One, three, or five years, or lifetime; the term cannot be shortened once selected. 1/3/5-year terms are removed automatically at expiration unless the person requests an extension in writing at least 30 days before expiry. No removal mechanism is published for the lifetime term.
Sign up for the longest exclusion time you can. Future you will thank you.
When it ends
A fixed term ends on its own at the end of the term; a lifetime term has no published way to lift it.
A fixed term. A one, three or five year term is removed automatically when it expires, unless a person requests an extension in writing at least 30 days before it ends. No removal mechanism is published for the lifetime term.
A lifetime term. Lifetime is one of the offered terms. No removal mechanism is published for it.
How to enroll
Open the Request for Voluntary Self Exclusion form.
Complete and sign the official form yourself, then submit it in person at any licensed gaming facility's problem gambling intake area (staff photograph you there) or at Gaming Commission headquarters in Schenectady during business hours, or mail the notarized form with your photo to NYS Gaming Commission, Director of Education & Community Relations, PO Box 7500, Schenectady, NY 12301-7500. We don't fill in or submit this form.
- Download the Request for Voluntary Self Exclusion form (Rev. 2/25/2026) from the program page. We don't fill in or submit this form.
- Complete the personal-information and physical-description sections, initial your chosen term (one, three or five years, or lifetime — it cannot be shortened once selected) and the acknowledgment section, and sign. Attach a recent photo (2x2 to 4x6 inches, taken within the last six months, full face from the neck up, no tinted glasses or hats); a facility takes this on site if you complete the form there.
- If you are mailing the form, sign it in front of a notary — required for mail submissions only, not for in person. The New York Council on Problem Gambling's VSE Support Program offers free help completing the form and notarization at 518-903-0217 or VSESupport@nycpg.org.
- Submit in person at any licensed gaming facility's problem gambling intake area or at Gaming Commission headquarters in Schenectady during business hours, or mail the notarized form with your photo to NYS Gaming Commission, Director of Education & Community Relations, PO Box 7500, Schenectady, NY 12301-7500.
- A one, three or five year term comes off automatically at the end of the term unless you request an extension in writing at least 30 days before it ends. No removal process is published for the lifetime term.
Official form (Rev. 2/25/2026) Program page
Before you count on it. Charitable gaming coverage is narrower than the program page suggests: this reaches only online/mobile raffle ticket sales, not bingo or bell-jar/pull-tabs. Online casino play isn't covered — it isn't legal in New York outside in-person play at the four upstate casinos. Tribal casinos (Seneca, Oneida, and the Saint Regis Mohawk Akwesasne Mohawk Casino) are not on this list — Seneca and Oneida run their own separate programs, and no self-exclusion program was found for Akwesasne. Whether residents or visitors qualify isn't stated. No processing time or confirmation method is published, so completing or mailing the form doesn't by itself confirm you're excluded.
Every route we checked
Routes that enroll you
- In person — Any licensed gaming facility's designated problem gambling intake area
A photo is taken on site by that property's security if the request is completed there. - In person — NYS Gaming Commission headquarters, Schenectady, NY
During normal business hours. - By mail — NYS Gaming Commission, Director of Education & Community Relations, PO Box 7500, Schenectady, NY 12301-7500
Must be notarized and include the required photograph.
Routes that get you a form or an answer, not an exclusion
- By email — VSESupport@nycpg.org
New York Council on Problem Gambling's VSE Support Program helps applicants complete the form, including notarization; not a submission address itself. - By phone — 518-903-0217
NYCPG VSE Support Program.
Requirements and sources
Sources read 2026-09-24. These are the program's requirements, not a record of anyone's enrollment.
- Terms available
- One, three, or five years, or lifetime; the term cannot be shortened once selected. 1/3/5-year terms are removed automatically at expiration unless the person requests an extension in writing at least 30 days before expiry. No removal mechanism is published for the lifetime term.
- Can a resident enroll
- Not verified: No source addresses residency for VSE eligibility.
- Can a visitor enroll
- Not verified: No source addresses residency for VSE eligibility.
- Identification
- Photo ID plus a recent (within 6 months) 2x2-to-4x6-inch photo showing the full face from the neck up, no tinted glasses/hats; taken by property security if the request is completed on site.
- Notarization
- Required only for mail submissions ('Forms submitted by mail must be notarized and include a photograph'); not required in person. The New York Council on Problem Gambling's VSE Support Program offers complimentary notary assistance.
- Witnesses
- Not verified: No witness requirement beyond the notary (for mail) is stated.
- Notarizing online
- Not verified: No source addresses whether a remotely notarized mailed form is accepted.
- How long processing takes
- Not verified: No processing-time interval is published.
- How you are told it took effect
- Not verified: No applicant-facing confirmation mechanism is published.
The form asks for: name and aliases, residential address, phone and email, Social Security number (voluntary), alternative government-issued ID number/type, date of birth, gender, height, weight, hair color, eye color, race/ethnicity, language spoken at home, term selection (initialled), acknowledgment/signature, photo (2x2 to 4x6 inches, within 6 months, full face from the neck up), notary block (mail submissions only).
- 9 NYCRR Chapter V Parts 5400-5410 (incl. Part 5402 Self-Exclusion) gaming.ny.gov · read 2026-10-24
- General Municipal Law Section 189 nysenate.gov · read 2026-09-24
- Request for Voluntary Self Exclusion gaming.ny.gov · read 2026-10-23
- Senate Bill S2614 (2025-2026 session) nysenate.gov · read 2026-09-24
- Use of the New York State Self-Exclusion Program (staff manual) exclusion.gaming.ny.gov · read 2026-09-24
- Voluntary Self-Exclusion gaming.ny.gov · read 2026-09-24
- VSE Process Improved (news release) gaming.ny.gov · read 2026-09-24