Post Conviction Intake Form

Post Conviction intake form

IMPORTANT: You must complete the form as required and click SUBMIT at the bottom of the page for it to be sent.

* Indicates required field

Potential Client's Name *

First

Last

Age *

Your Name *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Conviction information

Case Number *

Exact Sentencing Date? *

What court was this in? *

Federal State County/Muncipality

What was the crime(s) convicted of? *

What was the Judge's name? *

What was your impression of the Judge? *

Where there any witnesses? *

Yes No Not Sure

What was your impression of the standout witnesses? *

What county or district was this in? *

What was the sentence? *

Type of trial? *

Jury Trial Bench Trial (Judge Only) No Trial (Guilty Plea)

Who was the prosecutor? *

What was your impression of the prosecutor? *

Client counsel

Was the client represented by attorney/counsel? *

Yes, Trial Counsel Yes, Trial & Appellate Counsel Yes, Appellate Counsel No Pro Se (Client Acted on their own behalf)

If YES above, Name of Attorney/Counsel *

First

Last

Counsel's Phone Number *

Counsel's Email *

What was your impression/relationship with previous counsel? *

Facts of the case

Provide a brief summary of the facts of the case *

What do you think led to the bad result? *

How can we help? And if we were completely successful, what would that success look like to you? *

Potential client housing information

Where is/was the potential client housed? Are they still incarcerated? *

If the client is currently a DOC inmate, what is his or her DOC identification number? *

documents

Upload Copies if available *

Max file size: 20MB

If you found us through referral, please provide the name of the person that referred you *

Submitting this form is for intake review purposes only and does not constitute an attorney client relationship.

Submit