Indiana Coalition Against Domestic Violence and the Resource Center
 

Protective Order Pro Bono Project of Indianapolis (POPBP)
Request for Help - Victim Form

 

The Protective Order Pro Bono Project and ICADV may be able to provide you with free legal counsel.

There are two ways of requesting assistance, either using a hard copy form that you open, print and mail in to us, or by filling out the online form below.

Mail In Form

To access the hard copy form (in Adobe Acrobat - pdf - format) click here.

On-Line Form

To contact us online, please fill out the form below completely and click the submit button when finished.

 

Name:

  

Are you a victim of domestic or intimate partner abuse?

  


Please explain your situation in the text area at right:

  

Do you currently have a criminal domestic abuse case pending?

  


If YES to above, give the Cause Number of the case:

 


Do you have a civil emergency or permanent protective order?

  



If YES to above, give the Cause Number of that case:

 


Date of Order:

 


The Protective Order Pro Bono Project may be able to provide you with free legal counsel. Please explain your situation, and include any possible violations of an emergency or permanent protective order.

 

Be as specific with times and dates as possible.
Include anyone who witnessed a violation.

What is the date and time of your next hearing and what kind of hearing is it?

  


Please give us a telephone number where we can reach you:

  



Please describe anything else we might need to know, and let us know specifically how we might help you.

  

Are you currently represented by counsel?

  


If so, who?

 


Do you work?

  


What is the main source of household income?

 


How many live in your household?

  


Is there a divorce pending in this case?

  


Cause Number:

 


Is there a paternity case in this matter?

  


Cause Number:

 


If it is safe to email you, please provide your email address in the box to the right. If you do not have a safe email address, leave this box blank.

  

    


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Indiana Coalition Against Domestic Violence
1915 W. 18th Street Indianapolis, IN 46202
Phone (317) 917-3685 or (800) 538-3393
Fax (317) 917-3695
Crisis Line 1-800-332-7385