CUAPB INTAKE
Please complete this form if you would like assistance with your case.
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Email *
What is today's date? *
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What is your name? *
Your phone number? *
Please list other affected person(s) and their phone number(s): *
What is the date of the incident (approximate if unknown)? *
What was the location of incident (city, state and street if known)? *
Please provide a description of the incident: *
What officers were involved?  Departments, names,  badge numbers, squad car numbers, whatever you know. If you were charged, this info should be on the ticket or police report. *
Was anyone arrested?  If so, where were they held?  Are they still in custody? *
Is anyone facing charges? If so, what are they charged with?  When is their next court date? *
Do you have a lawyer?  If so, who? *
Were there witnesses?  If yes, please list names and contact info. *
Were there injuries?  What kinds of injuries.  Did the injured person get medical care?
(If anyone was injured, be sure to take pictures of the injuries and make sure they get medical care to document the injuries.) *
Was anyone's employment affected? How? *
Was anyone's housing affected? How? *
What is the affected person(s) race? *
Age? *
Disability status (if relevant):
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