First Amendment Clinic Intake Form

Please fill out the fields below to submit your case to the First Amendment Clinic.

Name: Name: First Last
Pronouns:
Email:
Phone: Phone: - ### - ### ####
Phone Alt: Phone Alt: - ### - ### ####
Address: Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Issue/Complaint:
Upload a File:

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Please sign to indicate that the information you have provided is true and correct; that you understand that by accepting this complaint, the First Amendment Clinic (“Clinic”) is not undertaking legal representation of you; and that the Clinic is not responsible for ensuring that any statute of limitations requirement or any other requirement or deadline is met in your case. We cannot promise you that the information you provide will lead to any specific action on the part of the Clinic. We will keep the personally identifiable information that you provided in this form confidential. You confirm you are not currently represented by an attorney.

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