ACLU of Mississippi Online Legal Assistance Intake Form

Do you feel that your civil rights have been violated? We may be able to help you!

The ACLU of Mississippi defends the Bill of Rights. We generally file lawsuits that affect the civil liberties of large classes of people rather than those involving single disputes between two parties. We do not charge for our services.

We do not handle criminal cases or family law. We cannot guarantee representation, and for this reason urge you to seek counsel even if filing with the ACLU. If we take your case, we will work with your attorney.

The following are examples of the types of cases we represent:
 -  Freedom of Speech and Press
 -  Freedom of Religion
 -  Freedom of Association
 -  Due Process
 -  Privacy
 -  Equal Protection
 -  Suits Against Private Organizations (discrimination being a common
    complaint here)
 -  Search and Seizure
 
For detailed explanations, please read the Bill of Rights. 

Your request will be carefully reviewed within the next several weeks.

Given the large number of requests we receive each week, the ACLU of Mississippi will not be able to handle any type of emergency problems or meet with you personally at this time.

The ACLU of Mississippi is not a direct legal services provider; rather, we are a private, non-profit organization engaged in community education, legislative action, and litigation on selected civil liberties issues. Our limited resources prevent us from accepting a large number of requests for legal representation. Thus, we can choose only those cases involving significant civil liberties / civil rights issues which would have a far-reaching impact. For further information about how the ACLU of Mississippi accepts cases, click here.

By filling out the below form, you understand that the ACLU of Mississippi is not undertaking legal representation of you at this time. Therefore, you must not expect advice or assistance through the ACLU of Mississippi in complying with any deadlines that frequently occur in most claims or grievances. If any emergency or other time constraint exists, you should retain private counsel, locate legal aid, or take the necessary actions yourself.

We will make every effort to let you know as soon as possible if we can assit you. However, it may take weeks. We appreciate your patience and thank you for contacting the ACLU of Mississippi.

Fill out the below form, send it, and if we think we can help in your case, we will contact you! Leave blank any area that does not require an answer. 

CONTACT INFORMATION:

Your Name:

Address:  

City:   State:        Zip Code:

Telephone:      Work Phone:  

Email Address:

Victim’s Name (if different):   

Victim’s Date of Birth:

COMPLAINT AGAINST:

Company/Government Agency:

Individual Name(s):

Address:  

City:          State:            Zip Code:

Phone:

 May we contact this person, company, or agency?        YES                    NO

NATURE OF COMPLAINT: (please check all that apply)

Abortion	Drug Testing	Prison - Abuse
Capital Punishment	Due Process	Prison - Condition
Church and State	Employment – Private	Prison – Medical Case
Court – Judicial Misconduct	Employment – Government	Prison – Religion Issue
Criminal Justice	Equal Protection	Prison - Other
Cruel and Unusual Punishment	Freedom of Association	Privacy
Curfew	Freedom of Religion	Students’ Rights
Discrimination – Age	Freedom of Speech	Search and Seizure
Discrimination – Gender	Freedom of the Press	Tenants' Rights
Discrimination – Disability	Immigration	Voting Rights
Discrimination – Race	Parole/Probation	Discrimination – Sexual Orientation
Police Misconduct		Other:

DESCRIPTION OF THE COMPLAINT:

 Where did this incident occur (city/county/state):

 When did this incident occur? (be as specific as possible)

 Please describe the incident in as much detail as possible.  

 WITNESSES TO THE INCIDENT:

Name:                            Phone:

Name:                            Phone:

Name:                            Phone:

 

Have you contacted another agency?      YES           NO    If so, what agency and what is the status of your complaint?

 

Have you consulted an attorney?       YES              NO   

If yes, please provide the following information:

Attorney's Name: 

Address:

City:    State:         Zip Code:

Telephone:     Fax:

What action, if any, is the attorney taking?

 

May we contact the attorney?        YES                 NO

Have you done anything on your own to try and address this problem?   YES               NO

If yes, describe your efforts:

What would you like the ACLU to do for you?

 

ARE YOU WILLING TO BE A PLAINTIFF IN LITIGATION?       YES             NO

EVIDENCE:

Email or mail copies of documentation, such as letters from government officials, relevant laws and policies, etc.  If you send documents, please DO NOT send the originals.  Send only photocopies of documents.  The ACLU of Mississippi cannot be responsible for returning documents.  

Email documents to intake@msaclu.org.  

Mail copies of documents to:

ACLU of Mississippi
P.O. Box 2242
Jackson, MS 39225

 I certify that I have read the information contained in this complaint and that all information I have given is accurate and complete to the best of my knowledge and belief.  I understand that by accepting this complaint, the ACLU of Mississippi is NOT representing me and that the ACLU is NOT responsible for meeting any deadlines or statute of limitation.  I hereby authorize the ACLU to use this information in any manner it deems necessary.

Your name: