Criminal Defense Intake Form

If other pronouns, please specify:

I prefer to be contacted by:

Phone

Activity Fee Paid?

Yes

Check all that apply

Undergraduate Student

Graduate Student

ASUM Employee

ASUM Senate Member

Charge(s) and date(s) of Citation (provide copies):

Arrest Date, Time, and Location:

Pre-Trial/Trial Date?:

Month

Day

Year

Are you currently represented by OPD or another attorney?

Yes

Describe circumstances of charges and any important details:

Attach relevant documents:

File size upload maximum is 16MB. File types allowed: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif, psd, kmz

DUI Only - Reason for traffic stop:

DUI Only - Preliminary Breath Test?

Yes

Refused

Preliminary Breath Test Result:

DUI Only - Intoxilyzer Breath Test?

Yes

Refused

Intoxilyzer Breath Test Result:

DUI Only - Blood test?

Yes

Refused

You will be notified as soon as possible how we are able to assist you. If you are given an appointment, this does not mean that you have retained us to represent you as your attorney. If we are able to represent you then we will sign a Retainer Agreement and you will pay an additional retainer fee. You are responsible for any legal requirements, deadlines and hearings. Sign your understanding:

Today's Date

Month

Day

Year

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ASUM

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