Potential Claims

We will contact you to let you know whether we can assist you

* Indicates required field

Name *

First

Last

Email *

Phone Number *

City of Residence *

Claim Type *

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 Incident *

Check all that Apply *

Arrested Charged Criminal Proceedings Pending

Police Department *

Personal Injury

Date of Injury *

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

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.

Submit

client intake form

PLease note: as of november 10, 2022
we are no longer accepting new clients or claims

We will contact you to let you know whether we can assist you

Police Misconduct

Personal Injury

Employment

the mission of the civil rights justice center is to offer a place where people can both understand their civil rights and learn how to ensure their access to those rights.

client intake form​PLease note: as of november 10, 2022we are no longer accepting new clients or claims

We will contact you to let you know whether we can assist you

Police Misconduct

Personal Injury

Employment

the mission of the civil rights justice center is to offer a place where people can both understand their civil rights and learn how to ensure their access to those rights.

client intake form

PLease note: as of november 10, 2022
we are no longer accepting new clients or claims