Defendant intake

Tell us about yourself and what support would help. You do not need to explain the alleged offense here.

Required fields are marked *. You can skip personal questions and discuss them with Andrea instead. Answers stay on this page until you submit; closing or refreshing clears them.

01 About you & staying in touch

Full name * Name you prefer to use Email Phone Safest way to contact you Safe contact times / message restrictions Preferred language Help you need to complete intake or communicate with us For example: an interpreter, reading assistance, or an accessible interview arrangement.

02 Your attorney & case

Attorney name / firm Attorney email Attorney phone County / court, if known Cause number, if known Next court date Are you currently in custody? Facility, if applicable Who is completing this form? Helper name / relationship, if applicable

03 Your life & priorities

Current living situation People or organizations you rely on for support School, training, and work background Family, caregiving, or other responsibilities Strengths, interests, and things you are proud of Support you would like help connecting with You can name general needs, such as housing, education, employment, or counseling. You do not need to give diagnoses or treatment details.What would you like Crossroads to understand or help you work toward? Questions you would like to ask Andrea

Please do not include Social Security numbers, detailed accounts of the alleged offense, privileged communications, or medical records. Submitting this form does not confirm that Crossroads has accepted the assignment.