Injunction for Protection - Women in Distress

WID recognizes that taking legal action against an abuser is an important step in keeping survivors safe. Obtaining an attorney, however, can have a huge financial burden. The Injunction for Protection Project (IFP) eliminates barriers to securing legal protection against an abuser.

IFP Attorneys at WID are Florida Bar-licensed & provide FREE legal representation & legal counsel in restraining order cases for:

Domestic Violence
Dating Violence
Sexual Violence
Stalking / Harassment / Cyberstalking

Services that are available include:

Meeting with survivors to determine whether filing an injunction is safe and appropriate
Completing and filing petitions for protection
Representation at the Temporary and Final Hearing
Representation at Violation Hearing
Representation at a hearing to Modify or Extend an Injunction
Representation at a hearing where the abuser is attempting to dissolve or dismiss the injunction

IFP legal representation is dependent on the survivor’s eligibility, and an initial conflict check will be completed upon receipt of the referral to ensure there are no legal conflicts of interest before proceeding to the client-interview stage. In addition, the IFP Project will make referrals to other agencies for services not available through the Project.

To request counsel, please complete & submit the referral form below. For more information, please contact:

Juliana Chereji Dunn, Esq., Program Director, IFP Project
954-760-9800 x1462 jdunn@WomenInDistress.org

Women In Distress 24-Hour Crisis Line
954-761-1133 / TTY/TDD 711

In case of emergency, call 911.

INJUNCTION FOR PROTECTION PROJECT (IFP) INTAKE / REFERRAL FORM

IFP Intake/Referral Form

Today's Date *

Next court date & time (if applicable)

Name: First, Middle, Last *

Date of Birth *

Is there a safe phone number where you can be reached?

Yes

Safe phone number where you can be reached *

Safe to leave a voicemail?

Yes

Safe to leave a text message?

Yes

Safe E-mail where you can be reached *

Safe address where you can receive mail (if available)

Did you receive information about this referral form from a staff member at Women In Distress? *

Yes

If you selected yes, please provide the name of the Women In Distress staff member who assisted you. *

If you selected no, please provide name/agency and phone number of the person who provided this referral.

If yes, which of these attorneys have you had a case with or against or consulted with? *

If yes, which of these attorneys have you had a case with or against or consulted with?

To your knowledge, has the person you are seeking an injunction against ever been represented by or consulted with any of the above attorneys? *

Yes

Have you consulted with or signed an engagement/retainer agreement with another attorney for this matter? *

Yes

What is the name, date of birth, and address of the person against whom you are seeking an Injunction? *

How are you related to or connected to the person against whom you are seeking an injunction? *

Do you have any minor (under 18) children in common with this person? *

Yes

If so, what are their names and dates of birth?

If you share children in common with this person, are you seeking:

An Injunction as to the children as well

Child support

Time-sharing / visitation agreement

** IF YOU ARE CURRENTLY THE SUBJECT OF A DCF INVESTIGATION OR HAVE AN OPEN DEPENDENCY CASE, PLEASE FILL OUT THE FIELDS IN THE FOLLOWING SECTION. WE HAVE SPECIALIZED DEPENDENCY ATTORNEYS WHO MAY BE ABLE TO HELP

Is there an open DCF Investigation regarding you and/or your children?

Yes

If yes, please provide the Name and Phone Number of the CPI

Do you have an open/pending Dependency Case? If so, please provide the following case information if known.

Yes

Case Number

Next Court Date

Name of Judge or General Magistrate

Name, DOB and Address of Children’s Other Parent/Guardian/Custodian

Name, DOB and Address of Other Adults who are involved in the DCF case/investigation (for example, your significant other or another family member who lives in your home)

Do you need an interpreter for a language other than English for your hearing or to speak with your attorney, if s/he does not speak your language? *

Yes

If yes to the above, what language?

Briefly describe the incident(s) [with dates & locations, etc.] that led you to seek an Injunction? *

THE FOLLOWING INFORMATION IS OPTIONAL AND IS COLLECTED FOR STATISTICAL PURPOSES ONLY. THE SERVICES PROVIDED BY THIS CENTER ARE OFTEN FUNDED BY GRANTS THAT REQUIRE THE COLLECTION OF STATISTICAL DATA. THE STATISTICS GATHERED WILL BE COMPLETELY ANONYMOUS. WE WILL NOT RELEASE YOUR NAME OR ANY OF YOUR PERSONAL OR IDENTIFYING INFORMATION TO OTHER AGENCIES WITHOUT YOUR CONSENT.

RACE / ETHNICITY RACE / ETHNICITY

AGE (check one)

Are you a Veteran?

Yes

Are you Deaf or Hard of Hearing

Yes

Are you currently homeless?

Yes

LIMITED RETAINER AGREEMENT: I do hereby retain THE INJUNCTION FOR PROTECTION PROJECT (IFP), solely for the purpose of obtaining and receiving information necessary to determine whether the matter that I have consulted the IFP Attorney about is a matter in which the attorney can or will provide me with representation. If, after reviewing the information related to my case, the attorney determines that s/he cannot accept my case, the Attorney will notify me of that fact, and will not act as my attorney with regard to this matter. I understand that even if the IFP Project is not able to represent me, it is possible that the IFP Project will provide me with a legal advice and counsel. The advice and counsel may be given in person or come in the form of a letter or telephone call. If I am provided with legal advice and counsel only, I understand that the IFP Project WILL NOT be representing me in Court or in any manner other than the consultation. If the Attorney accepts your case, you will be notified and asked to sign an Engagement Agreement to Accept Legal Services.

CONSENT FOR RELEASE OF INFORMATION: I authorize the INJUNCTION FOR PROTECTION PROJECT (IFP) to obtain, inspect, copy and receive any information in my possession pertaining to myself and any minor children. This release is given without limitation and applies to both confidential and non-confidential information in my possession from any source and in any form (including, but not limited to substance abuse assessments/evaluations; psychological and psychiatric evaluations; therapy treatment plans and progress summaries; medical records; and urinalysis results, etc.). This release will expire within 90 days of the date below.

By checking this box and signing below, you are confirming you have read and agree to the Limited Retainer Agreement and Consent for Release of Information above. *

I have read and agree to the Limited Retainer Agreement and Consent for Release of Information

Signature *

Clear

Injunction For Protection Legal Project

Services that are available include:

INJUNCTION FOR PROTECTION PROJECT (IFP) INTAKE / REFERRAL FORM