CRIMINAL INTAKE FORM

CRIMINAL INTAKE FORM

Contact Information – Information of Person Completing This Form on Behalf of Self or Someone Else

CLIENT INFORMATION

LIST ALL CHARGES PENDING AGAINST CLIENT (including the Code Section if known)

CLIENT'S HEALTH INFORMATION

Emergency Contact – Who May we Contact if we Cannot Get a Hold of Client?

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).

Additional Information About Your Case

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.