Spouse/Significant Other Information
Most Recent Emplyment History
Information Regarding Your Claim
What is the basis of your claim?
Civil Rights Violations Based on:
Have you solicited the Representation of any other Attorney(s) in reference to this claim? (If so, whom and why did you not proceed with them?)
IF CURRENTLY INCARCERATED, COMPLETE THE FOLLOWING
During this period of incarceration, have you experience disciplinary actions? (If so, how many times & for what reason):
CRIMINAL HISTORY SUMMARY
OTHER GENERAL INFORMATION
Answer the following questions to the best of your ability. If your answer to ANY of these questions is YES, please explain on the prompt below.
Use this page to identify and describe any person(s) who have DIRECT knowledge regarding your claim(s). Include people which you deem to be either friendly to your claim, hostile to you or your claim or neutral. REMEMBER, THIS INFORMATION MAY PROVE TO BE VERY IMPORTANT TO YOUR CASE.
Folluw Up Questions