Legal Intake Form

Please fill out this form as completely as possible. If we need information in addition to what is on this form, we will contact you. We will respond as quickly as possible.

However, please be aware that due to the number of requests for assistance we receive, we are able to accept only a small percentage of cases. You must understand that unless and until the ACLU agrees to take your case, you are solely responsible for any and all statutes of limitations or other deadlines which might apply to your specific situation. If you have concerns about statutes of limitations or if you feel your case demands immediate attention, you may wish to seek advice from an attorney.

The ACLU-CT generally files cases that affect the civil liberties of large numbers of people, rather than those involving a dispute between two parties. The basic criteria are:

Does this case raise significant civil liberties or civil rights issues?

What effect will this case have on people other than the parties involved?

What is the potential impact of the case?

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Contact Information

Prefix

First Name *

Last Name *

Suffix

Email *

Street Address *

Address Line 2

City *

State *

Zip *

Phone *

Alternate Phone

Date of Birth

I'm submitting this form of behalf of *

myself

another person

Incident Details

Where did the incident occur? (city/county/state) *

When did the incident occur? (be as specific as possible) *

What is the problem? Please describe your civil liberties difficulty in as much detail as possible. (Include names of all people, companies, and/ or government agencies against whom you have a complaint) *

If you were given an explanation of what happened, tell us who gave you the explanation, and what the explanation was.

Why do you think this happened to you?

Have you filed a complaint with any other agencies? If so, please describe and include the dates, case number, case title, court of jurisdiction, judge, opposing counsel and current status of the case.

Are you represented by an attorney in this matter? If so, indicate the attorney's name and phone number: *

Please describe any attempts you have made to resolve this problem. Include names of individuals/agencies and dates, and give a brief description of each result:

Please state clearly what you would like the ACLU to do for you. *

Disclaimer and Notice

This Survey does not give legal advice, and you should not rely on it as legal advice. You should not rely on the information you get from this site and should speak with a lawyer to get advice on your specific situation. We also cannot promise that the information on this site is complete, accurate, or up-to-date.

This Survey is not a solicitation or an offer by the American Civil Liberties Union and its affiliates to represent you. We cannot promise you that the information you provide will lead to any specific action on the American Civil Liberties Union or its affiliates part. Once you complete the survey, the American Civil Liberties Union of Connecticut may not do anything—including contact you—about your situation.

If you fill out this Survey, you agree that the American Civil Liberties Union, the national ACLU or its affiliates, if identified as part of the Survey, or one of its coalition partners may use the information you give us, as long as we don’t include your name, address, email or phone number, for one or more of the following purposes: (1) legislative testimony, (2) litigation; (3) contacting a city, state or federal agency; or (4) telling your story to the public, including the media. If the American Civil Liberties Union, the national ACLU or its affiliates, or one of its coalition partners wants to identify you, we will contact you prior to doing so.

We will keep your name, address, telephone number and email confidential unless you give us permission to use it or unless we are ordered to turn it over by a court (although we will attempt to prevent any disclosure).

Certification *

I certify that I have read all the information in the complaint form and given accurate and complete information to the best of my ability. I understand the ACLU-CT is not undertaking my legal representation or case by accepting the complaint. I also agree that ACLU-CT is authorized to use this information in any matter it deems necessary.

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