Criminal Law Questionnaire


Full Name:


Date of Birth:

(ex 1991-12-31) Place of Birth:
Age:
Citizen:


Co-Accused:

When Arrested:

New Charge(s):

Pending Charge(s):


Physical Address:

Mailing Address:

or

How Long:

Who do you live with:

Can you return if released:

Telephone(s):

Email:


Health Problems (Doctor, Psychiatrist/Psychologist, Rx):


Relationship Status and Length:

Name of Spouse:

Children (Names and Ages):

Child Support and Amount:

Custody:

How often do you see your kids:


Education and Diplomas/Licenses:

Name of School:

Church or Other Activity:


Employment:

Length of Employment:

Name and Address of Employer:

Employer Support:

Need License for Work:

Sureties or Cash Bail Available:


Gladue:

Heritage:

Home reserve (family there, ever been, status of reserve):

Residential Schools:

Domestic/Substance abuse:

Racism:

Connection with Heritage:


Notes: