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Intake Questionnaire

All information provided on this form is confidential and will not be shared unless your express permission is given.

Subject of Complaint

My Complaint is About: *

Criminal Justice

Disability Rights

Education

First Amendment – Freedom of Association

First Amendment – Freedom of Religion

First Amendment – Freedom of Speech or Expression

HIV/AIDS

Immigrant’s Rights

Lesbian, Gay, Bisexual, Transgender

Native American Rights

Police Practices – Excessive Force

Police Practices – Racial Profiling

Police Practices – General

Prisoner – Medical/Mental Health Care

Prisoner – Legal Mail/ Attorney Visitation/ Law Library

Prisoner – Parole and Probation

Prisoner – General

Privacy and Technology

Racial Justice

Reproductive Freedom

Sex Offender Issues

Student’s Rights

Voting Rights

Women’s Rights

Other (Please do not select unless NONE of the preceding categories covers your complaint)

If "other," please describe:

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