DEFENSE RESOURCES FOUNDATION, INC.

Financial Support Application

To ensure that we have all the information required to assess your application properly, please fill out this form as completely as possible. All information provided will be kept confidential.

Section I: Personal Information

Name(Required)

First Last

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Contact Number(Required)

Email(Required)

Enter Email Confirm Email

Previous Legal History

Please list any prior convictions or legal actions against the defendant. Please include the nature of the charge(s)/claim(s), the date the case begun and the final disposition of the case and, if applicable, the sentencing

Affiliation(Required)

Yes

Are you, or have you ever been, affiliated with any political organizations, civil rights groups, or other pertinent associations?

If yes, please list and describe the nature of your involvement:

Section II: Financial Information

Is the defendant currently employed?(Required)

Yes

Employer's Name

Employer's Address

Street Address Address Line 2 City State ZIP Code

Employer's Contact Number

Position/Job Title

Duration of Employment

Input number

Direct Supervisor's Name

First Last

Direct Supervisor's Contact Number

May we contact your direct supervisor to inquire about your employment?(Required)

Yes

Annual Income

Other Sources of Income

Please list any other sources of income, e.g., investments, second job, business income, rental income, etc

Have you or the defendant sought financial assistance for legal defense from other sources?

Yes

Please specify

Section III: Legal Representation Information

Are you the defendant or representing the defendant?

Defendant

Attorney

Attorney's Full Name

First Last

Law Firm (If Applicable)

Attorney Address

Street Address Address Line 2 City State ZIP Code

Attorney's Contact Number

Attorney's Email

Bar Number

Attorney's Full Name

First Last

Law Firm (If Applicable)

Attorney Address

Street Address Address Line 2 City State ZIP Code

Attorney's Contact Number

Attorney's Email

Bar Number

Section IV: Case Information

Cout Name

Court Address

Street Address Address Line 2 City State ZIP Code

Case Number

Charge(s) Being Faced

Date of Alleged Incident

Name(s) of All Parties Involved

Current Stage of Court Proceedings

e.g., pre-trial, trial, post-trial, appeal, etc.

Are there any pending hearing dates?

Yes

Date of Hearing

Time of Hearing

The purpose of the Hearing

Section V: Case Details

Brief Description of the Case

Please describe the circumstances of the alleged incident, focusing especially on elements relating to self-defense or political persecution.

What type of assistance are you seeking from the Defense Resources Foundation, Inc.?

e.g., legal counsel, investigators, expert witnesses, etc.

Estimated Amount Requested

Nature of Defense

Self-defense

Defense of another

Defense of property

Political affiliation/persecution

Other

Please check all that apply

If Other, please explain

Why do you believe the defendant is being charged due to political affiliation or has a valid justification defense?

Media Coverage

Yes

Has your case received any media attention?

If Yes, please provide links or references to any news articles, videos, or other media.

Supporting Documents

Drop files here or

Accepted file types: pdf, Max. file size: 2 GB.

Please attach any supporting documents that may help our review, such as arrest records, court documents, media reports, or personal testimonies. While not mandatory, these can provide additional context to your application.

References

Please provide the names and contact information for up to three people who can speak to the nature of your case, your character, or both. This could be a community leader, coworker, family member, etc.

Name

First Last

Relationship

Address

Street Address Address Line 2 City State ZIP Code

Contact Number

Name

First Last

Relationship

Address

Street Address Address Line 2 City State ZIP Code

Contact Number

Name

First Last

Relationship

Address

Street Address Address Line 2 City State ZIP Code

Contact Number

Personal Statement

In your own words, describe why you believe you should receive financial support from Defense Resources Foundation, Inc. Highlight any unique or compelling aspects of your situation that might not be evident from the rest of the application.

Additional Information

Provide any other information you believe would be relevant for the Defense Resources Foundation, Inc., to consider.

Declaration

Name(Required)

First Last

Signature Date(Required)

Signature(Required)