Medley Crisis Management – Initial Intake Review
This confidential intake helps us determine whether Medley Crisis Management is the appropriate support for your situation. We are not a law firm and do not provide legal representation.
Full Legal Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address City, State, Zip Code
Preferred Contact Method
*
Email
Phone Call
Text Message
Other
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Reason For Contact
Briefly describe the situation that led you to contact Medley Crisis Management.
*
Detail of your situation
0/500
What type of issue best describes your situation?
*
Employment / Workplace
Unemployment Benefits
Housing / Eviction
Education / School
Other
What could happen if this issue is not addressed in the next 30–60 days?
Job loss
Loss of housing
Loss of income or benefits
Legal consequences
Academic consequences
Other
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Timeline & Key Events
When did this situation begin?
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Month
-
Day
Year
Date (Best Guess)
List the most important events related to this issue (include dates if possible).
*
Please Be Detailed
Are there any upcoming deadlines, hearings, or notices?
*
Yes
No
If yes, please explain and include dates.
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Current Filings & Representation
Have you filed or initiated any of the following?
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EEOC complaint
Unemployment appeal
Internal HR grievance
Court filing
School complaint or appeal
None
Are you currently working with any of the following?
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Attorney
Legal Aid organization
Union representative
Social worker or case manager
No one currently
If yes, please briefly explain.
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Documentation & Evidence
What documentation do you currently have?
*
Emails
Text messages
Letters or notices
Write-ups or disciplinary actions
Policies or handbooks
Medical documentation
Audio or video recordings
No documentation yet
Are these events mostly documented in writing or verbal?
*
Mostly written
Mostly verbal
A mix of both
None
Upload any relevant documents (optional)
Browse Files
Drag and drop files here
Choose a file
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Personal Context
Is there anything you believe you could have handled differently?
*
Yes
No
If yes, please explain briefly.
Have you missed any deadlines or failed to respond to notices?
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Yes
No
If yes, please explain.
What steps have you personally taken so far?
*
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Expectations
What are you hoping Medley Crisis Management can help you with?
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Strategy and guidance
Advocacy and escalation
Documentation organization
Understanding options and rights
Support during crisis
Other
What would a successful outcome look like to you?
*
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Acknowledgment & Consent
Today's Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: