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Public Defender Confidential Intake Form

  1. Please include area code

  2. Please include area code

  3. Please include area code

  4. 1. Were you born in the U.S.?

  5. If you answered "Yes" please skip to Question #2

    If you answered "No" please complete all of the following questions.

  6. 1a. Do you have documents available?

  7. 1b. If no,

  8. 1c. Have you been previously deported?

  9. 1d. Family ties that are U.S. citizens?

    List all that apply

  10. 1e. Family ties that are Legal Permanent Residents?

    List all that apply

  11. 1f. Do you have an immigration and customs enforcement (ICE) detainer?

  12. If you answered "Yes" to question #1 please skip to this section

  13. 2. Are you currently employed?

  14. 3. Housing

  15. 4. Are you currently recieving any student loans?

  16. 5. Are you currently in the military; served in the military, or actively pursuing a military career?

  17. 6. Was there any police misconduct or injury that occured during this incident that you would like to discuss further with your attorney?

  18. 7. Do you currently have any of these other types of cases pending?

  19. 8. Are you in need of information about any of the following?

    Please check all that apply

  20. Leave This Blank: