Client Application

Protect Our Defenders Foundation has created a network of lawyers and POD staff willing to assist survivors of military sexual assault and sexual harassment – including service members, veterans, civilians assaulted by members of the military, and bystanders and whistleblowers who are suffering retaliation for intervening or reporting sexual assault or harassment – at no cost. Please fill out the form below to assist us in trying to provide such pro bono (free) legal counsel or casework assistance for you.

First Name:	* Required
Middle Name:
Last Name:	* Required
Email:	* Required
City:	* Required
State:	* Required
Current Zip Code:	* Required
Permanent Zip Code	* Required
Cell Phone:	* Required
Gender:
Where did you hear about the Pro Bono Network?	* Required
Are you currently active duty?	* Required
Branch of Service	* Required
Current or last Rank/Rate	* Required

This inquiry pertains to (check all that apply):
Sexual assault or rape
Sexual harassment
Other sexual offense
Whistleblower/bystander retaliation
Errant medical diagnosis (personality disorder, bipolar, adjustment disorder)
Ongoing or prior child abuse (physical, sexual) or neglect AND the child is still under 18

Briefly explain what you are seeking assistance with:	* Required
Dates or Year(s) of Assault:	* Required
Did you know the assailant?	* Required
Was the assailant a service member?	* Required
Was the assailant in your unit?	* Required
Was the assailant in your chain of command?	* Required
Current or last rank of your assailant	* Required
Where did the assault take place (on base/off base/both)?	* Required
Did you report the assault?	* Required
If you reported, how was it reported?	* Required
If you did not report, briefly list the reasons why:
Have you faced or are you currently facing any negative administrative or punitive actions by your command?	* Required
If you reported, have you experienced retaliation since reporting?	* Required

What was the response from reporting? Please answer all:
An investigation was conducted	* Required
Charges were filed (preferred)	* Required
The case went to an Article 32 Hearing	* Required
The case went to trial	* Required
The trial resulted in a conviction	* Required
The court-martial is still pending	* Required
Did the assault have an impact on your career?	* Required
Did you leave the service?	* Required
If yes, what is the characterization of your discharge?	* Required


Please select your race/ethnicity. Your response helps us better understand who we are serving.	* Required
Do you identify as LGBTQ? Your response helps us to better understand who we serve.

Please leave this checkbox blank

Legal Services Program

Please fill in this form COMPLETELY

If you have any questions, please contact us at intake@protectourdefenders.com

Legal Services Program

Please fill in this form COMPLETELY If you have any questions, please contact us at intake@protectourdefenders.com

Please fill in this form COMPLETELY

If you have any questions, please contact us at intake@protectourdefenders.com