Today's Date

Your first and last name

Your email address

Your phone number (numbers only, no symbols)

Your Address

Address Line 2

City

State

Zipcode

Relationship to incarcerated individual

Your loved one's first name

Your loved one's middle name

Your loved one's last name

Your loved one's Date of Birth

Loved one's register number

Your loved one's case number

Is your loved one a U.S. citizen? YES NO

Please select the state of incarceration. Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming

Where is your loved one currently incarcerated? Please provide facility's name if possible

What federal court was your loved one sentenced out of? If you do not know the court, do you know the city and state?

What state is the incarcerated person originally from? Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming

What is the incarcerated person's hometown?

What sentence did the judge give your loved one?

What date did your loved one's incarceration begin, including any pre-trial or pre-sentencing incarceration that was credited to their sentence?

With good-time credits etc., do you know what your loved one's expected release date will be?

What state did the cannabis conviction occur? Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming

Please describe (in as much detail as possible) the underlying offense.

Was your loved one charged with any other drugs, other than marijuana and/or psilocybin, in the current offense? YES NO

Does your loved one have any PRIOR convictions? YES NO

If yes, please try to include more information about the prior conviction (such as year, case number, jurisdiction, and a brief description). Please indicate whether any convictions are violent or sexual in nature.

Do you know of any detainers? If so, please tell us anything you know about them.

Is your loved one CURRENTLY represented by an attorney? (This means post-conviction as opposed to pre-trial). YES NO

Are you or your loved one currently on supervised release and would you like assistance getting off of supervised release early? YES NO

Does your loved one have any serious medical conditions we should know about?

Does your loved one have a release plan? Tell us a little about it. For example, who would they live with? How would your loved one obtain medical care?

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