Black Lives Matter - Los Angeles Bail/Legal/Medical/Emergency Support Application for Protestors
Please complete the following information to request support for legal expenses, court costs, medical bills, and/or other related emergency expenses incurred as a result of participation in a protest, demonstration or action for Black freedom.

For questions or assistance completing this form, please call 424-256-1911.
Sign in to Google to save your progress. Learn more
Are you applying for funds to support: *
What is the total dollar amount that you are requesting? *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report