Application Form

All fields marked with * are required.

Client First Name *

Client Middle Name

Client Last Name *

Client Suffix

Client Date of Birth

The Nashville Community Bail Fund recognizes the criminal legal system is racist. We collect race data about the people we serve to ensure that our impact counteracts these racial disparities rather than contributes to them. Please share the way your client describes their race.

Client Race

Client Gender

Pronouns

The Nashville Community Bail Fund recognizes that the criminal legal system is trans- and homophobic. We collect this data about the people we serve because of their particular vulnerability while incarcerated. We will never disclose an individual’s LGBTQ status but we may use aggregated data to expose disproportionate impact. LGBTQIA means lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual or allied.

LGBTQIA Status

Are there any special circumstances you'd like us to know about? Tell us your story--we want to help however we can.

OCA Number

Case Number

Charges

Charge Type

Arrest Date

Total Bail Amount

Initial Bail Amount (if applicable)

Next Court Apperance Date

Facility where person is held

Supervision

Is this person experiencing homelessness?

Does the person have reliable transportation?

What is the person's employment status?

Client Phone Number

Client Email Address

Community Contact 1 - Name

Community Contact 1 - Relationship

Community Contact 1 - Phone Number

Community Contact 1 - Email Address

Community Contact 2 - Name

Community Contact 2 - Relationship

Community Contact 2 - Phone Number

Community Contact 2 - Email Address

Attorney Name

Attorney Phone Number

Attorney Email Address

Your Name *

Your Relationship To The Client *

Your Phone Number *

Your Emai Address *

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