Please fill out this form as completely as possible. If we need information in addition to what is on this form, we will contact you. We will respond as quickly as possible.

However, please be aware that due to the number of requests for assistance we receive, we are able to accept only a small percentage of cases. You must understand that unless and until the ACLU of Florida agrees to take your case, you are solely responsible for any and all statutes of limitations or other deadlines which might apply to your specific situation. If you have concerns about statutes of limitations or if you feel your case demands immediate attention, you may wish to seek advice from an attorney.

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First Name *
Last Name *
Email *
Full Address (Street, City, State) *
Phone *
A-Number, Nationality & Country of Origin (if immigration matter)
What is the problem? (Include people, companies, and/or agencies against whom you have a complaint). *
Where did the incident occur? (city/county/state)
City *
County *
State *
When did the incident occur? *
Witnesses/persons with information regarding your complaint: (please include name, telephone, & whether we may make contact.
Have you filed a complaint with any other agencies? If so, please describe and include the dates, case number, case title, court of jurisdiction, judge, opposing counsel & current status.
Are you represented by an attorney in this matter? If so, indicate the attorney's name and phone number:
Please describe any attempts you have made to resolve this problem. Include names of individuals/agencies & dates, & give a brief description of each result.
May we contact other individuals, agencies or organizations that may be relevant to your request? Is there anyone that you do not want us to contact?
If you have documents that may help evaluate your case, describe them briefly. (We will call if we need a copy of the documents).
Please state clearly what you would like the ACLU to do for you. *
How did you hear about us?
Disclaimer and Notice
This Survey does not give legal advice, and you should not rely on it as legal advice. You should not rely on the information you get from this site and should speak with a lawyer to get advice on your specific situation. We also cannot promise that the information on this site is complete, accurate, or up-to-date.

This Survey is not a solicitation or an offer by the American Civil Liberties Union and its affiliates to represent you. We cannot promise you that the information you provide will lead to any specific action on the American Civil Liberties Union or its affiliates part. Once you complete the survey, the American Civil Liberties Union of Florida may not do anything—including contact you—about your situation.

If you fill out this Survey, you agree that the American Civil Liberties Union, the national ACLU or its affiliates, if identified as part of the Survey, or one of its coalition partners may use the information you give us, as long as we don’t include your name, address, email or phone number, for one or more of the following purposes: (1) legislative testimony, (2) litigation; (3) contacting a city, state or federal agency; or (4) telling your story to the public, including the media. If the American Civil Liberties Union, the national ACLU or its affiliates, or one of its coalition partners wants to identify you, we will contact you prior to doing so.

We will keep your name, address, telephone number and email confidential unless you give us permission to use it or unless we are ordered to turn it over by a court (although we will attempt to prevent any disclosure).

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