Home
About
Vision & Mission
WEN Leadership
Patrons
Board of Directors
WEN Board of Advisors
WEN Board of Advisors (Royals)
WEN Board of Advisors (Non-Royals)
Executive Directors
Continental Directors
WEN Empowerment Groups
Start a WEN Chapter
Program Areas
Govt Relations
Civic Duties Activities
Judicial Education
Govt Relations Workshops
Customary Law
Common Law
Voter Education | Registration Drives
VITA ASSISTANCE APPLICATION
Culture Competency Advocacy Mediation MAP
Prevention & Diversion
Supportive Intermediary Restorative Practice
Cultural Heritage Education
Govt. Rel. Services
cCAMP – Network of Legal Expert
Legal Referral Service
Interpreter Services
General & Welfare Assistance
Crises Assistance Application
FITT-IN – Relocation Assistance
Immigration
Government Relations
Family Life & Community
Age Grade
Relationship Management
Men/Women In Family & Community
Parenting
Ageing
Welfare Assistance
Health
Culinary Traditions
Care Package
Ethnic/Culture Advocacy
Health Workshops
Mental Health
Education
CompTIA Authorized Academy Partner
GEDworks
Mentoring
Scholarships
WEN Book Club
WEN Creative Writing
WEN Magazine
Economic Resource & Development
Economic Resource & Development
Resume Building Workshop
Solar Powered Hydroponics System
International Relations
WEN Annual Ethnic Folklore Festival
Chieftaincy Title
Ethnic Studies Experts
Roots LinkUp Tour
History Workshops
Arts and Crafts
Science & Technology
Peace Making & Keeping
WERC PARTICIPANTS
WERC Participation Invitation
Recreation
WEN BASKETBALL LEAGUE OF TEAMS
WEN DB OF VERIFIED ATHLETES
Tours
Engage
Volunteer With WEN
Start a WEN Chapter
Affiliate With WEN
AFFILIATE PROJECTS
Incubate Your Project
Internship & Fellowship
Internship
Fellowship
Ethnic Studies Experts
Project Collaborators
Research & Development
Events | Workshop | Conference
Talenthon
workshops
Conferences
Festivals
Scholarships
WEN Book Club
Careers
Contact
DONATE
Home
About
Vision & Mission
WEN Leadership
Patrons
Board of Directors
WEN Board of Advisors
WEN Board of Advisors (Royals)
WEN Board of Advisors (Non-Royals)
Executive Directors
Continental Directors
WEN Empowerment Groups
Start a WEN Chapter
Program Areas
Govt Relations
Civic Duties Activities
Judicial Education
Govt Relations Workshops
Customary Law
Common Law
Voter Education | Registration Drives
VITA ASSISTANCE APPLICATION
Culture Competency Advocacy Mediation MAP
Prevention & Diversion
Supportive Intermediary Restorative Practice
Cultural Heritage Education
Govt. Rel. Services
cCAMP – Network of Legal Expert
Legal Referral Service
Interpreter Services
General & Welfare Assistance
Crises Assistance Application
FITT-IN – Relocation Assistance
Immigration
Government Relations
Family Life & Community
Age Grade
Relationship Management
Men/Women In Family & Community
Parenting
Ageing
Welfare Assistance
Health
Culinary Traditions
Care Package
Ethnic/Culture Advocacy
Health Workshops
Mental Health
Education
CompTIA Authorized Academy Partner
GEDworks
Mentoring
Scholarships
WEN Book Club
WEN Creative Writing
WEN Magazine
Economic Resource & Development
Economic Resource & Development
Resume Building Workshop
Solar Powered Hydroponics System
International Relations
WEN Annual Ethnic Folklore Festival
Chieftaincy Title
Ethnic Studies Experts
Roots LinkUp Tour
History Workshops
Arts and Crafts
Science & Technology
Peace Making & Keeping
WERC PARTICIPANTS
WERC Participation Invitation
Recreation
WEN BASKETBALL LEAGUE OF TEAMS
WEN DB OF VERIFIED ATHLETES
Tours
Engage
Volunteer With WEN
Start a WEN Chapter
Affiliate With WEN
AFFILIATE PROJECTS
Incubate Your Project
Internship & Fellowship
Internship
Fellowship
Ethnic Studies Experts
Project Collaborators
Research & Development
Events | Workshop | Conference
Talenthon
workshops
Conferences
Festivals
Scholarships
WEN Book Club
Careers
Contact
Contact Support Team
Membership Application Form
Volunteer Assignment Form
Non-Disclosure Agreement
Start A Chapter
Family & Community Support
CRIMINAL INTAKE FORM
CRIMINAL INTAKE FORM
Please enable JavaScript in your browser to complete this form.
Date / Time of Application
*
Date
Time
Contact Information – Information of Person Completing This Form on Behalf of Self or Someone Else
I am Completing This Intake Form For
Self
Relative – Parent
Relative – Spouse
Relative – Child
Relative – Sibbling
Contact's Name
*
First
Last
Contact's Email
*
Contact's Phone Number
*
Contact's Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
— Select country —
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
CLIENT INFORMATION
Client Name
*
First
Last
Client Email
*
Client Phone Number
*
Contact's Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
— Select country —
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Client's Age Range
*
Under 18
18 – 24
25 – 34
35 – 44
45 – 54
55 – 64
Above 64
Client's Marital Status
*
Single (Never Married)
Married
Divorced
Widowed
Client's County of Residence?
*
Client's Immigration Status?
*
Citizens
Conditional and Permanent Residents
Non-Immigrant Status
Undocumented
Is Client Employed?
*
Yes
No
Client's Job Title/Description
*
Client's Employer's Name and Address (copy)
*
LIST ALL CHARGES PENDING AGAINST CLIENT (including the Code Section if known)
Case Number
*
Date of Offense
*
Date
Time
Date / Time of Next Court Hearing if known
*
Date
Time
Full Name of Accuser
*
Client Relationship to Accuser
*
Was Client Arrested?
*
Yes
No
What is the date, time, location and police department?
*
Is Client Out on Bail? Secured or Unsecured?
*
Yes
No
Was a Protective Order Issued?
*
Yes
No
Was Client on Pre-Trail Services?
*
Yes
No
Was Client Held in Jail Overnight?
*
Yes
No
If Yes, How Many Nights Was Client in Jail For?
*
Is Client Currently on Probation?
*
Yes
No
If Yes, List Name and Telephone Number of Probation/Parole Officer
*
Does Client Have Any Previous Criminal Convictions?
*
Yes
No
If Yes, List (include charge, approx date and outcome)
*
Has Client Ever Failed to Appear in For a Court Appearance or Been Held in Contempt of Court? If So, Please Provide the Details
*
Please Provide the Name, Address and Telephone Number of Any Eye Witnesses or Alibi Witnesses
*
Please Provide the Names, Addresses and Telephone Numbers of As Many Persons that Can Attest to Client's Character
*
Was Anyone Else Arrested With Respect to Client's Current Charge(S)?
*
Yes
No
Do You Have an Alibi?
*
Yes
No
Please Provide More Details of What Lead to This Situation
*
CLIENT'S HEALTH INFORMATION
Does Client Any Mental Health Concerns?
*
Yes
No
Has Client Ever Been Institutionalized?
Yes
No
What Age Was Client When Diagnosed of Mental Issues?
Under 18
Above 18
What Would Client Like the Lawyer to Know About Client's Mental Health Issue?
*
If Client is Above 18, Would Client Like Us to Contact Your Family Member?
*
Yes
No
What is Client's Family Members Contact Information?
*
Emergency Contact – Who May we Contact if we Cannot Get a Hold of Client?
Emergency Contact Name
*
First
Last
Emergency Contact Phone
*
Emergency Contact Email
*
Emergency Contact's Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
— Select country —
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Social Support System
Social support system refers to a network of people (formal or informal) – that deliberately reinforces enduring and noble principles, philosophies, and practices (See WEN mission – www.worldebonynetwork.com) that single parents can turn to for emotional, practical, economical, etc., Support. Individuals from such social support networks are willing to invest and sustain their resources i.e., time, money, etc., without feeling regrets, passing judgments, engaging in gossips, to achieve the expected goal(s).
Do You or Client Belong To Any of These Social Support Groups?
*
Cultural Association
Fraternity & Sorority
Church
Peer
Other
Has the Group Been Notified or Aware of This Matter?
*
Yes
No
Which One of These Support Groups Have Shown Concern?
*
How Has the Support Group Assisted Client in Dealing With This Matter?
*
Are You or Client Satisfied With the Role They've Played in Rectifying Your Situation?
*
Yes
No
Have Your Friends and Family Shown Their Support in This Matter?
*
Yes
No
Which Ones Showed Their Support (Check One or Two Boxes)?
*
Family
Friends
What Role Have They Played?
*
Financial Support
Emotional Support
Other
If Other, Specify
*
Are You Satisfied With the Role They've Played in Rectifying Your Situation?
*
Yes
No
Is This Case Hindering You From Carrying on Your Daily Activities?
*
Yes
No
In What Way(s) is This Case Hindering You?
*
What Did You or Plan to Do About It?
*
Additional Information About Your Case
How do You Want the Lawyer to Help You?
*
Signature
*
Clear Signature
Culture Competence Advocacy & Mediation Program (cCAMP)
WEN’s legal referral services (LRS) WENLRS is under our Culture Competence Advocacy and Mediation Program (cCAMP), which is a culture based resource available to you to meaningfully manage your lawyer’s expectation and support your lawyer, especially with culture competence based resources to handle your case. As a potential client, you are also provided with the choice of requesting this advocacy and mediation service when completing your intake form if you feel it will help you meet your lawyer’s expectations. It will also provide you the necessary peace of you mind you need to ensure the lawyer is taking certain cultural information into consideration to manage your case as well as present before the judge. We find that this has been a tremendous help in the past, especially for clients of strong ethnic convictions. If you will like to use this service, please sign below.
I Permit WEN to Use cCAMP to Manage My's Lawyer Expectation and Support My Case
*
Yes
No
Signature
*
Clear Signature
Submit