Vermont Legal Intake

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.

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.

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First Name *

Last Name *

Email *

Street Address *

City *

State *

Zip *

Phone *

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

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

What is the problem? (Include names of all people, companies, and/ or government agencies against whom you have a complaint) *

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: *

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

Is there anyone that you do not want us to contact? if so, tell us who it is: *

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

Witnesses or persons with information regarding your complaint: (please include name, full address, telephone, and whether we may contact the person)

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.

May we contact any other individuals, agencies or organizations that may be relevant towards understanding the problem you've written us about?

Yes

If you have documents that you believe may help us evaluate your case, please describe them briefly. (We will call you if we want to obtain a copy of the documents):

How did you hear about us?

If you are a prisoner or detainee with a complaint about the conditions of your confinement or detention, you generally must exhaust all grievance procedures before filing a lawsuit; please describe in detail the grievance procedures you followed:

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 Vermont 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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