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File A Complaint

PLEASE BE ADVISED: The purpose of this Intake Questionnaire is for the ACLU of Mississippi ("ACLUMS") to assess and possibly investigate whether it can provide you with representation. Filling out this Intake Questionnaire does not form an attorney/client relationship between you and the ACLUMS. The ACLUMS does not represent you unless and until the ACLUMS and you have both signed a written retainer agreement. Unless and until the ACLUMS agrees to take your case, you are solely responsible for any and all statutes of limitations or other deadlines applicable to your specific situation. To protect your rights, please consult with a private attorney to determine deadlines applicable to your case. Do not wait to hear from the ACLUMS before proceeding with your matter.

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Contact Information

Please enter your contact information.

My Complaint is Against The Following (optional)

Please enter information about the individual, agency, and/or organization your complaint is against.

Details of Complaint

Please provide a brief factual account of the events leading you to file this complaint. Please include dates, places and the names of the people directly involved. What rights do you feel were violated? Did the person or agency that you believe violated your rights offer any explanation for what happened? If so, please briefly describe their explanation. What steps have you taken to complain/appeal/resolve this issue, including filing complaints with other organizations or government entities? Please state clearly and specifically what you would like the ACLU of Mississippi to do for you and the ultimate resolution you would like to see.

What happened?*

Please provide a brief factual account of the events leading you to file this complaint. Please include dates, places and the names of the people directly involved.

(Must be 2000 characters or less)

 

How have you already tried to solve your issue?*

Please include information about any response from the person/agency you believe violated your rights.

(Must be 2000 characters or less)

 

Please state clearly and specifically what you would like the ACLU of Mississippi to do for you.*

Please include the ultimate resolution you would like to see.

(Must be 2000 characters or less)

Witness Information (optional)

If you have a witness to support your claims, please enter their information below.

Attorney Information (optional)

If you are represented by an attorney in relation to this matter, please provide the following:

Lawsuit Information (optional)

If a criminal or civil lawsuit has been filed against you or on your behalf in relation to your complaint, please provide the following:

BY SUBMITTING THIS FORM YOU AGREE THAT ALL OF THE INFORMATION PROVIDED IS TRUE AND CORRECT TO THE BEST OF YOUR KNOWLEDGE.