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About
Areas of Practice
Police Misconduct & Civil Rights Violations
Employment Problems
Personal Injury & Car Accidents
Consumer Rights
Potential Claims
Blog
Recent Posts
This Day In History
Archive
Shop
Contact
We will contact you to let you know whether we can assist you
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Name
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First
Last
Email
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Phone Number
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City of Residence
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Claim Type
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Miscellaneous
Police Misconduct
Employment
Personal Injury
Next Section Instructions:
Based on your claim type, please fill out the appropriate section below. Please note, you do not need to fill out all sections, just the section you feel is most applicable for your case.
Police Misconduct
Date of Indicent
*
Date of arrest or initial conflict
Check all that Apply
*
Arrested
Charged
Criminal Proceedings Pending
Please check all that apply
Police Department
*
Personal Injury
Date of Inury
*
First Insurance
*
Second and/or Third Insurance
*
Employment
Employer and Position Title
*
Date of Hire and Date of Termination
*
Union
*
Yes
No
Upload File
*
Max file size: 20MB
If you have a few documents relating to your potential claim, you may attach them here
Upload File
*
Max file size: 20MB
*Please limit the volume of documents to those requested
and
those detrimental to your claim*
Police Misconduct:
If an arrest and/or search was involved, please include a copy of the police report(s), warrant, return, and affidavits.
Personal Injury:
Please attach relevant photos, reports, or other relevant documents.
Please tell us about your claim
*
*Please include dates (even estimates) for the events relevant to your claim. We will need to determine whether your claim could be barred by the Statute of Limitations*
Check before submission
*
I understand that submitting this intake form does not guarantee my representation by the Civil Rights Justice Center, PLLC, in the above matter
The Civil Rights Justice Center has one attorney and receives numerous daily submissions. We will make every effort to contact you within a business week, of your submission. Thank you for your patience.
While you may have a viable claim, our office may be unable to assist you. In the event we are unable to assist you, we will try our best to provide you with alternative resources.
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