bail fund application 123 Referrer InformationInformation about the person completing this applicationWhat is your name?(Required)Name of the person filling this application First Last Your relationship to this person(Required)What is your relationship to the person in jail?SelfRelativePartnerFriendSocial WorkerLawyerOtherYour email address(Required)The KCCBF will email you with the status of this request once we are able to review it. Your phone number(Required)May we text you at this number?(Required) Yes No Applicant InformationInformation about the person needing bail assistanceLegal name of applicantName of the person who needs bail assistance First Middle Last Applicant's date of birth(Required) MM slash DD slash YYYY Applicant's Race(Required) Black/African American White Asian/Pacific Islander South Asian Hispanic/LatinX American Indian Middle Eastern/North African Other If other, what is their race? Applicant's Gender(Required) Male Female Non-Binary Trans-Male Trans-Female Not Listed Preferred Pronouns(Required)Detainee's preferred pronouns She/Her He/Him They/Them Other Unknown Is the applicant in a jail or detention center inconsistent with their gender identity?For example, is the detainee a man in a women's jail, or a woman in a men's jail? Yes No What is the applicant's primary language?(Required)EnglishSpanishOtherUnknownIf other, what is their primary language? Applicant's phone number(Required)Please provide the applicant's best contact number Applicant's email If released, will they have a home or other place to go?(Required) Yes No Is this person employed?YesNoUnknownIf yes, please provide the address:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Will the applicant be released into a treatment program?(Required)YesNoUnknownIf yes, what is the name of the treatment program? Does the applicant need to be released by a certain date to secure their spot in treatment?(Required)YesNoUnknownPlease provide date (if known) MM slash DD slash YYYY Bail InformationName of detention center applicant is being held in(Required)We serve Jackson, Cass, Clay, Johnson, and Wyandotte counties Inmate or Case Number(Required)Enter 'Unknown' if applicable What has the applicant been charged with?(Required) Has the applicant previously been arrested for this charge in the last 12 months?(Required)YesNoUnknownWas the applicant arrested as a result of driving with a suspended license?(Required)YesNoIf yes, was the applicant's car towed?(Required)YesNoUnknownAre you trying to apply for Project GreenLight?PGL helps with expenses such as driver's license renewal/replacement/reinstatement, vehicle registration/renewal/insurance/inspection, or minor car repairs Yes No, I need help paying bail to getting someone out of jail Click Here to Learn More and Apply to Project GreenLight What is the applicant's TOTAL bail amount?(Required)This is the amount set by the judge, not the 10% fee or the amount charged by a bondsperson. At this time we cannot accept bail requests exceeding $5000Please enter a number from 0 to 5000.Does the applicant have hold in other cities or counties?YesNoUnknownIf yes, where? Bail ConditionsInformation about the requirements the applicant has to fulfill once released from custodyDoes the applicant have pre-trial release conditions?For example, house arrest, pre-trial monitoring, drug testingYesNoUnknownIf yes, please explain Do you know when the applicant's next court date is?(Required) Yes No When is the applicant's next court date?(Required) MM slash DD slash YYYY Does the applicant have an attorney?YesNoUnknownPlease list the attorney's name, email, and phone number (if known) Is the applicant on probation?YesNoUnknownIf yes, please list probation officer's name, email, and phone number (if known) If we can provide bail assistance, would you like us to contact you?(Required) Yes No If there is another person we can contact, please write their name and phone number here, along with their relationship to the relationship Is this the first time the Kansas City Community Bail Fund has been contacted about bailing out this applicant?(Required) Yes No Has the KCCBF previously posted bail for this applicant?YesNoUnknownPlease note additional information you’d like us to consider--for example, is the applicant at risk of losing a job, a home, or custody of children; or is the applicant facing serious health issues?How did you hear about the KCCBF?(Required) A Friend or family member Case manager An attorney or legal program Instagram Facebook Twitter Word of mouth A flyer or employee at the detention center Previous applicant Other Please read the following statements and indicate that you understand each statement by checking the boxesNote: You won't be able to submit the form until each of these are individually checked. The Kansas City Community Bail Fund is a non-profit organization with limited funds. I understand that the Bail Fund cannot help everyone who applies for assistance I understand that the Bail Fund will only contact those that they are able to help. I understand that I may not post anything about this request for bail assistance on any social media platforms. I confirm that the detainee does not have the financial resources to pay bail. It is a true statement that without assistance from the Kansas City Community Bail Fund, this person will remain in pre-trial detention. I agree to waive my right to bail money that the KCCBF posts on my behalf
