Participatory Defense Online Intake Form
This is an online intake form for individuals facing charges and families with loved ones who are incarcerated. Please fill out the following form and a Participatory Defense Organizer will contact you ASAP. If you have not received a call within 48 hours please call us at (352) 559-4719
Name of loved one facing charges (Please indicate if you are the person facing charges)
Are they currently incarcerated?
Clear selection
What is their Date of Birth?
MM
/
DD
/
YYYY
If your loved one is in the Florida Department of Corrections, Please give us their DC #
Where is your loved one incarcerated?
How long have they been incarcerated?
What is their bail amount?
Is the family able to afford bail?
Clear selection
How much can the family afford?
What was your loved one charged with?
Who is your loved one's attorney?
When is your loved one's next court date?
What is your Name?
What is the best number to contact you at?
What is your email address? (it is ok if you don't have one)
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