CCJ - Legal Assistance Form

Title

Full Name*

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Case Information:

Key Issue*

Brief Description of the Case.*

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Case Status*

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How would you like the Center to help in your case*

Are you currently represented by an attorney in regard to this issue?

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If your answer above is YES, please fill
out the information below.

Attorney(s) for Plaintiff/Appellant:

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Address

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Attorney(s) for Defendant/Respondent:

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Phone Number

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Address

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DISCLAIMER
By submitting this form, I agree that I have not entered into an attorney client relationship with the Center for Constitutional Jurisprudence, that the Center for Constitutional Jurisprudence does not represent me, and that no representations have been made to me indicating that the Center for Constitutional Jurisprudence will undertake legal representation of any party in the matter described. I understand that information provided by me may be shared with third parties to determine whether the Center for Constitutional Jurisprudence may represent me without coming into conflict with the interests of their existing clients. If the Center for Constitutional Jurisprudence, in its sole discretion, agrees to undertake legal representation on this matter, that agreement will be set forth in a separate written document.

I agree to the above disclaimer*

yes