YASP Participatory Defense Hub Intake Form
Please complete Hub Intake Form.
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Email *
Your name *
Name of young person
Are you completing this form as: *
Required
Who are you reaching out on behalf of? (name) 
 *
When is the next court date? (Date, Time, & Room #) 
What is the best way(s) for us to contact you?
What is your phone number? 
 *
What is your email? 
 *
Are (you/they) being charged as a youth or as an adult? 
Do you know who the lawyer is representing the person facing charges? (name) Have you spoken with them about the case? 
Have (you/they) ever been arrested before? If yes, what was the outcome?
What activities are (you/they) involved in? 
What areas of life would (you/they) like support in (finding employment, connecting to counseling, etc.) and/or what are some of (your/their) goals? 
Support people or family members we can get in contact with if we can't get in contact with (you/them)? 
Would (you/they) be interested in talking more with the Youth Hub team down the line about additional resources and supports?  *
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