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APPLICATION FOR LEGAL AND BAIL ASSISTANCE

INSTRUCTIONS

Before completing the application please note:

  1. No attorney/client relationship is created by submitting this application.
  2. The purpose of this application is to provide the attorney with information to prepare for the initial consultation and to determine program eligibility.
  3. You do not need to complete the entire application at this time, however the more complete the application, the faster we can review your case.
  4. If you need assistance in completing the application, please call us at (954) 361-3664.
  5. Paper applications are available as well.
  6. Please allow up to 48 hours for someone to contact you regarding your application.

APPLICATION

Complete This Section Only If Applying for Someone Else


PERSONAL INFORMATION

The information you provide is confidential.

IMMIGRATION INFORMATION

If you are not a U.S. citizen, a criminal conviction could lead to your removal from the United States. We do not have expertise in immigration law. You should seek advice from an immigration attorney before accepting any resolution of your criminal case.

CONTACT INFORMATION


CURRENT ARREST INFORMATION


CRIMINAL RECORD

Whether you have a record, the kind of prior convictions, their date, and the type of offense can affect your sentence if you are convicted now. Your record can also affect the outcome of this case. A criminal conviction may have occurred any time that you went to court and were fined, place on probation, or sentenced to jail or prison.

ABOUT YOUR FAMILY


EMPLOYMENT INFORMATION


EDUCATION INFORMATION


MILITARY SERVICE


MEDICAL HISTORY


FINANCIAL STATEMENT

This is required by the Clerk of Courts

Other Income


Assets


Debt and Liabilities


COMMENTS


SIGNATURE SECTION

By typing my name below, I attest that everything is the truth to the best of my knowledge and ability. The purpose of this form is to gather the information needed by the attorney before scheduling an initial consultation. The purpose of an initial consultation is for the attorney to advise you, the prospective client what if anything, may be done for you, and what the minimum fee (if any) will be.

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