Youth Justice Project Intake Form

Attorney Name

First Name

Last Name

Client Name

First Name

Last Name

Client's Current Age (Birthdate, MM/DD/YR)

Client's Age at the Time of the Alleged Offense

Charges/Convictions

Jurisdiction

Procedural Posture

Support Requested:

Litigation

Investigation

Mitigation

Experiential

Parole and Second Look

Training

Transitions (OYA to ODOC; institution to community; etc)

Notes (please provide any additional information you believe we should know)

Phone

(###)

###

####

Email

We keep any/all information confidential. We will not share, confirm, or deny the information you provide to us with any third party. For immediate assistance with an issue, please contact Trevor Walraven at [email protected].