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Name:
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Pronouns:
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He/Him
They/Them
Other
If other pronouns, please specify:
Email:
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Phone Number:
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I prefer to be contacted by:
Phone
Email
Address:
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Date of Birth
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Student ID
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Activity Fee Paid?
*
Yes
No
Check all that apply
Undergraduate Student
Graduate Student
ASUM Employee
ASUM Senate Member
Charge(s) and date(s) of Citation (provide copies):
*
Arrest Date, Time, and Location:
*
Initial Court Date:
Entry of Plea:
Omnibus Hearing:
Pre-Trial/Trial Date?:
Month
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January
February
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2028
Are you currently represented by OPD or another attorney?
Yes
No
Witnesses:
Describe circumstances of charges and any important details:
*
Attach relevant documents:
File size upload maximum is 16MB. File types allowed: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif, psd, kmz
DUI Only - Reason for traffic stop:
DUI Only - Preliminary Breath Test?
Yes
No
Refused
Result:
DUI Only - Intoxilyzer Breath Test?
Yes
No
Refused
Result:
DUI Only - Blood test?
Yes
No
Refused
Result:
You will be notified as soon as possible how we are able to assist you. If you are given an appointment, this does not mean that you have retained us to represent you as your attorney. If we are able to represent you then we will sign a Retainer Agreement and you will pay an additional retainer fee. You are responsible for any legal requirements, deadlines and hearings. Sign your understanding:
*
Today's Date
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Month
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February
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Day
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Year
--
2020
2021
2022
2023
2024
2025
2026
2027
2028
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