Name *

First Name

Last Name

Phone *

Please include the best phone number where BALT can reach you.

(###)

###

####

Are you completing this request form for yourself or for someone else? *

I'm requesting services for myself

I'm requesting services for someone else

What type(s) of support are you seeking? *

Please select all that apply.

Filing for expungement of my criminal records

Recalling a warrant for my arrest and requesting a new hearing date

Some other legal service(s) not listed (please specify below)

I want to request the arrest support hotline for an action/protest I'm organizing in Baltimore City or Maryland

Are you currently represented by a Maryland attorney for the service(s) requested? *

No

Yes

Unsure

By checking the box below, I authorize BALT to contact me by phone and/or email regarding my request. *

I agree