Request for Legal Help Form

This form is designed to assist the ACLU in the evaluation of your grievance. Please be as specific and detailed as possible. It is important that all questions be answered completely.

Unfortunately, our resources are limited. We take cases that raise significant constitutional or civil liberties issues and which impact others in the same situation. We cannot take all cases offered us. We are unable to take many cases, even those concerning real injustices. If your complaint is not pursued by our office, it does not mean it is without merit. You may wish to consult our Resources page for information on how to get other help.

If we need further information, we have your address and/or telephone number and can request any documents necessary. We dispose of our files after six months.

Although we keep our files confidential, submitting cases via email is not a secure means of transmission. If you do not wish to submit your form via email, you may fill out the form, print it and mail it to:

ACLU of Ohio Intake Department
4506 Chester Ave.
Cleveland, OH 44103

1. Complaint Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip *

Daytime Phone *

Evening Phone

Email *

2. My complaint is against

First Name

Last Name

Agency

Street Address

Address Line 2

City

State

Zip Code

Phone

May we contact this person?

Yes

3. Date of situation giving rise to your complaint

Date

Month

Day

Year

4. Witnesses or persons with information about your complaint

First Name

Last Name

Street Address

Address Line 2

City

State

Zip Code

Phone

May we contact this person?

Yes

5. Have you filed a complaint with any other agencies?

Have you filed a complaint with any other agencies?

Yes

If yes, please describe in the following space and include the dates.

6. Prisoner or detainee complaints

If you are a prisoner or detainee who has a complaint concerning the conditions of your confinement or detention, you must exhaust all grievance procedures before contacting us. If this is the case, please provide a detailed description of the grievance procedures you followed.

7. Current representation

Are you represented by an attorney in this matter?

Yes

If yes, please provide the following:

Attorney's First Name

Attorney's Last Name

Agency or Law Firm

Street Address

Address Line 2

City

State

Zip Code

Phone

8. Pending lawsuits

Has a criminal or civil lawsuit been filed against you or on your behalf?

Yes

If so, please provide the following:

Case Number

Case Title

Date of Filing

Court With Jurisdiction

Judge

Opposing Counsel

Current Status of the Case

9. Complete description of complaint.

Please describe IN DETAIL, in a brief summary, all the events that led you to file this complaint.

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 Ohio 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).

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