Advocates for Wrongfully Convicted /Printed Prisoner Questionnaire

IMPORTANT! Please read Advocates for Wrongfully Convicted's Criteria before completing this form!

* required information

PRISONER INFORMATION:

*Name:

Date of Birth:

*Age:

*Mailing Address:

*City:

*State:

*Zip:

Name of nearest relative:

How related:

*Crime(s) convicted of:

*City/State crime(s) committed:

*DNA used to convict (Y/N):

*How convicted:

*Innocent (Y/N):

*Date Convicted:

*Length of sentence:

*Date eligible for parole:

*How long in prison:

*Name of Prison:

*Location: (city/state):

*Name of trial lawyer:

*Paid or Public Defender

*Do you have an appellate lawyer (Y/N):

Name:

Paid or Public Defender

*Appeal filed (Y/N):

Date filed:

Ruling reached (Y/N):

Result of appeal:

*DNA available for testing (Y/N):

Type of DNA (if applicable):

*Expectations of A4WC:

Comments:

CONTACT INFORMATION:

*Name:

*Relationship to Prisoner:

*Mailing Address:

*City:

*State:

*Zip:

*Phone:

Email:

*Why you feel prisoner is innocent: *Why you contacted A4WC::

*Capability to raise money (legal fees, DNA testing , PI, etc.):

*Your expectations of A4WC:

Comments:

Print this page by clicking the "Print this page" button; fill out contact information and mail to prisoner to have him fill out prisoner information; have prisoner mail form to:

Adovocates for Wrongfully Convicted

2020 S. Flying Heart Lane

Tucson, AZ 85713-7309