Listen

* Date of Birth

Gender

* Residence (City, Town, RM)

Did the incident occur in the province of Saskatchewan?

Yes

No

* Do you know the person(s)?

Providing information about the other party will help ensure that the lawyer you speak with does not represent the other person/party. This information will be used for this purpose only.

Yes

Perpetrator name

Perpetrator Date of Birth

Perpetrator occupation

Does the perpetrator live with you?

Yes

No

Company/Organization

No

* Do you have a private email address?

We STRONGLY prefer to communicate through email because we provide a lot of important information including the information you need to meet with a lawyer or partner. It is critical that this email address is secure and private from anyone else. If you do not have an private email address, you can create one using a service like Gmail or Yahoo.

Yes

* Email

No

* Please provide us with a safe way to contact you. (Select one or more)

Phone

* Phone

Is it safe to leave a message?YesNo

Text

* Cell phone

Is it a shared device?YesNo

Do you need translation services?

Yes

Translation language

No

Immigration status

* Terms of Service

I understand that my personal information is being collected only to administer the LISTEN program. The Program will not otherwise disclose the personal information I have provided, except as required by law. If you provide identifying information about a victim or perpetrator of child abuse we have a duty to report the matter to the police or child protection services. Children can include anyone who is or who apparently is under 18.

This Program relies on the support of a number of individuals, organizations, employees and volunteers. None of these individuals, organizations, employees or volunteers shall be responsible or liable for any claims in connection with the free legal services that I receive from this program.

Application Information