civil rights violation intake form

Civil Rights Legal Intake Form

Please note that the Law and Mediation Offices of Kelly Chang receives a high volume of requests for legal help.  Response times may vary.

A member of our Intake Team will be in contact with you at the earliest opportunity.  Thank you for your understanding.

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Do you have an attorney?
(Please be specific).
(e.g., government official, school, employer, etc.)
Is there a Court Case?
Are you the employer or employee?
Have you requested an accommodation?
Disclaimer: By completing and submitting this form, I acknowledge and agree that: (1) no attorney-client relationship with Law and Mediation Offices of Kelly Chang has been created by my submission of this form; (2) by accepting this form for review, Law and Mediation Offices of Kelly Chang has not agreed to represent me or any other person or entity in this matter in any capacity or to otherwise provide me or any other person or entity with any legal services related to this matter; (3) no attorney-client relationship or agreement for representation exists unless and until a separate written representation agreement is signed by both me and Law and Mediation Offices of Kelly Chang; (4) any information I have provided Law and Mediation Offices of Kelly Chang may be shared within Law and Mediation Offices of Kelly Chang as well as with outside third parties to the extent such is necessary or convenient for Law and Mediation Offices of Kelly Chang to review, analyze, or seek legal assistance for me in the matter submitted; and (5) Law and Mediation Offices of Kelly Chang has not agreed to review or act upon my submission within any specific period of time, so that if this is a legal emergency or is otherwise time-sensitive, including but not limited to the applicability of any statute of limitation or other time limitation or constraint, I may not rely and am not relying upon Law and Mediation Offices of Kelly Chang to protect my rights and interests and that I should seek and retain legal counsel from persons or entities other than Law and Mediation Offices of Kelly Chang in order to protect whatever legal right or interests I might have.