This form takes about 3 minutes to complete. You may be entitled to significant compensation.

Were you sexually abused while held at any of these facilities in North Carolina? *

Did the abuse involve a staff member or employee of the facility? *

Can you tell us the name, job title, or anything you remember about the person who abused you? *

Share anything you remember – their name (first, last, or nickname), job title or role at the facility, and any physical details like approximate age, height, build, hair color, tattoos, birthmarks, or other distinguishing features. Even partial details help.

Approximately how old were you when the abuse started? *

Approximately when were you held at the facility? *

Approximately when did the abuse occur? *

How often or how many times did the sexual abuse occur? *

Were you threatened or forced physically by the abuser? *

Did the abuser offer you anything in return like special privileges or other items? *

Did you report the abuse? *

Did you tell anyone after the abuse was over? *

How would you say the sexual abuse has impacted you in your life? *

Have you ever had a psychological or psychiatric counseling/therapy regarding the abuse? *

To help our team fight for you, we need to understand the extent of the abuse that happened. Can you please describe what happened in as much detail that you are comfortable sharing? *

The more detail you provide, the stronger your case. Everything you share is confidential.

Are you currently incarcerated? *

Did the facility know the abuse was taking place? *

Are you currently working with a lawyer or law firm for this situation? *

Your information is 100% confidential and only shared with our legal team. You pay nothing unless we recover compensation for you.

First Name *

Last Name *

Phone *

Email *

Date of birth *

Gender *

Address

Street Address *

City *

State *

Postal Code *

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