Request PCRA or Federal Habeas Representation Name of person submitting request(Required) First Last Phone(Required) Country Phone Number Contact Email(Required) Enter Email Confirm Email Name of person seeking representation (petitioner)(Required) First Last Date of birth of petitioner(Required) Month Day Year Status of the petitioner(Required) Incarcerated / In Custody On Probation Other Petitioner's Inmate Number(Required)Please write "N/A" if on probationJail or prison where the petitioner is incarcerated(Required)The docket or case number of the criminal case(Required)Please include what county or district the case was inThe date the conviction was finalized(Required)How long has it been since the petitioner finished their direct appeal?What was the petitioner convicted of?What were the charges on which they were sentenced?What type of criminal trial did the petitioner have?(Required) Jury Trial Judge Trial / Waiver Trial Other For which of the following is the petitioner seeking representation?(Required) PCRA Federal Habeas Is this the first PCRA/Federal Habeas filing? Yes No What claim do you wish to raise?(Required)On what new evidence or ruling do you wish to base the petition? Name of referring attorney or firm, if applicable Δ
