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Name:
Address:
Phone:
Email address:
Date of birth:
Race (for statistical purposes only):
American Indian or Alaskan Native
Arab or Middle Eastern
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Pacific Islander
Other race
Two or more races
White or Caucasian
Gender (for statistical purposes only):
Are you currently represented by an attorney? If so, what is the attorney’s name and phone number?:
Describe the problem for which you need legal help, including when and where the event happened. Also include the names of people, law enforcement agencies, and schools which are involved:
How did you hear about JCAP’s services?:
The Juvenile and Children’s Advocacy Project is a nonprofit legal services organization at the University of Houston Law Center.