LeDuc Montgomery LLC
2210 W Main Street, Suite 107-328
Battle Ground, WA 98604
+1 (704) 702-6934
This intake form is for prospective clients with civil rights matters who are currently housed in a prison or jail facility in Oregon.
If AICS s do not have an email address, use alicia@leducmontgomery.com.
Contact information: Inmate Contact Info
Prefix
First name
*
Middle name
Last name
*
Date of birth
Company
Emails
Address
*
Type
Upon submission, a copy of this form will be sent to the primary email.
Work
Home
Other
Primary
Default email false
Add email
Addresses
Street address
Country
Australia
Canada
United Kingdom
United States
---------------
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Türkiye
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
City
State/Region
Alaska
Alabama
Arkansas
American Samoa
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Northern Mariana Islands
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
United States Minor Outlying Islands
Utah
Virginia
Virgin Islands, U.S.
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Province/Region
Zip/Postal code
Address type
Work
Billing
Home
Other
Primary
Default address false
Add address
Date First Contact Mailed
Inmate SID Number
What prison or jail are you currently housed in?
Prison
Jail
Other
Which facility? Federal, state, or county?
What prison are you currently housed in?
Select an option
Not currently in an Oregon state prison facility
Coffee Creek Correctional Facility (CCCF)
Columbia River Correctional Institution (CRCI)
Deer Ridge Correctional Institution (DRCI)
Eastern Oregon Correctional Institution (EOCI)
Oregon State Correctional Institution (OSCI)
Oregon State Penitentiary (OSP)
Powder River Correctional Facility (PRCF)
Santiam Correctional Institution (SCI)
Snake River Correctional Institution (SRCI)
South Fork Forest Camp (SFFC)
Two Rivers Correctional Institution (TRCI)
Warner Creek Correctional Facility (WCCF)
What jail are you currently housed in?
Select an option
Baker County Jail
Benton County Jail & Corrections
Benton County Juvenile Facility
Clackamas County Jail
Clackamas County Juvenile Detention Center
Clatsop County Detention Center
Clatsop County Juvenile Detention Center
Columbia County Jail
Coos County Juvenile Detention Center
Coos County Sheriff's Jail
Crook County Jail
Curry County Sheriff's Jail
Deschutes County Adult Jail
Deschutes County Juvenile Detention Center
Douglas County Jail
Douglas County Juvenile Detention Center
Grant County Jail
Harney County Corrections
Jackson County Jail
Jackson County Juvenile Detention Center
Jefferson County Adult Detention Center
Josephine County Jail
Josephine County Juvenile Detention Center
Klamath County Jail
Klamath County Juvenile Department
Lake County Jail
Lane County Jail
Lane County Juvenile Detention Center
Lincoln County Jail
Lincoln County Juvenile Detention Center
Linn County Jail
Malheur County Correctional Facility
Marion County Correctional Facility
Marion County Juvenile Detention Center
Marion County Work Release Center
Morrow County Jail
Multnomah County - Wapato Facility
Multnomah County Court Holding Facility
Multnomah County Detention Center
Multnomah County Iverness Jail
Multnomah County Juvenile Detention Center
NORCOR Adult
NORCOR Juvenile
Pendleton Police Jail
Polk County Jail
Sherman County Jail
Tillamook County Jail
Umatilla County Correctional Facility
Union County Correctional Facility
Wallowa County Sheriff's Office
Wasco County Jail
Washington County Jail
Washington County Juvenile Detention
Wheeler County Jail
Yamhill County Jail
Yamhill County Juvenile Detention Center
Not currently housed in a jail
Do you expect to be released from custody within 1 year?
Yes
No
I don't know
Have you filed a lawsuit against Oregon Department of Corrections (ODOC) before?
Yes
What was the result?
No
I don't know
What date did the incident/harm/injury occur? If there were multiple incidents, what is the date of the most recent incident?
Where did the incident/harm/injury occur?
Did you file a grievance about the incident?
Yes
No
I don't know
Was your grievance substantiated or denied?
Substantiated
Denied
Other
If your grievance was denied, have you filed an appeal?
Yes
No
I don't know
Did you file a tort claim notice yet?
Yes
No
I’m not sure
Have you filed an existing lawsuit for this incident?
Yes
What is the case number?
No
I'm Not Sure
What issues are you contacting us about?
Physical Assault
Sexual Assault
Bias or Discrimination (Any Basis)
Excessive Use of Force by Staff
Retaliation
Medical Care Issues
ADA - Americans with Disabilities Act Issues
Failure to Protect from Harm
Excessive Punishment
Chemical Spray
Access to Programs or Law Library Resources
Ramos/Non-Unanimous Jury Verdict
Other
How have you been harmed by this incident?
Serious Physical Injury (broken bone, surgery, permanent damage)
Mild Physical Injury (bruising, cut, scrape, bloody nose, temporary wound that has healed)
Required hospitalization or outside medical transport
Financial costs (fines, fees)
Loss of Privileges (housing, removal from program, loss of job, etc.)
Retaliation (put in segregation, write up, threats of harm, actual harm, transfer to another facility, verbal threats, written threats, other)
Commissary (purchased first aid, medications, self care materials from commissary in connection with the incident)
Damage to Personal Property (Taking property, losing property in transfer, damaging property, breaking property)
Emotional Distress (Going to BHS, fear, anxiety, trouble sleeping, loss of appetite, PTSD, nightmares, crying, sadness, depression, chronic stress)
Sexual Abuse (rape, sexual touching, non-Consentual touching, solicitation, sexual harassment)
Other
Were there any eye-witnesses to the incident/harm/injury?
No, just me and the person doing it
Yes, other AICs
Yes, other prison staff
Yes, other third parties
What correctional facility staff were involved? (Name, Rank/Title, What their role in the incident was)
What other adults in custody were involved? (Name, SID, Contact info, What their role in the incident was)
Tell me the short version of what happened:
Anything else that is important to know?