TDCJ/SID #
Immigration #
Full Name
Address
City
State
Zip Code
Employer
Employer’s Address
Telephone numbers:
Residence:
Work:
Cell:
Email
Drivers License #
Date of Birth
Emergency Contact:
Name:
Address:
Telephone:
Do you understand and write in English?
YesNo
If no, what is your primary language?
Who helped you prepare this form?
Will they be available to translate future correspondence during this process?
Are you a Judge?
If yes, provide Court, County, City, State
Are you an attorney?
If yes, are you currently in litigation with the attorney named in this grievance?
Attorney Name
Attorney Address
Telephone Numbers:
Home:
Other:
Have you or a member of your family filed a grievance about this attorney previously?
If yes, please state its approximate date and outcome.
Please check one of the following:
This attorney was hired to represent meThis attorney was appointed to represent meThis attorney was hired to represent someone else
If this attorney represents someone else, please check one of the following:
I am a family member or wardI am a trustee or executorI am the judge, prosecuting attorney, or jurorI have an interest or connection with this case
Details of representation:
Date the attorney was hired or appointed
Fee arrangement with the attorney
How much did you pay the attorney?
Upload supporting documentation (limit 10MB)
Are you currently represented by an attorney?
If yes, provide information about your current attorney
Do you claim the attorney has an impairment?
If yes, please provide specifics.
Where did the activity occur?
County:
City:
If your grievance is about a lawsuit:
Name of Court:
Title of Suit:
Case Number and Date Filed:
Connection to the lawsuit:
Explain in detail why you think this attorney has done something improper.
How did you learn about the grievance process?
Yellow PagesCAAPInternetAttorneyOtherWebsite
