Client Referral Form

If a question does not apply, please put "n/a"

All fields marked with * are required.

Attorney Information

Attorney Name *

Attorney Email *

Attorney Phone *

Attorney Address *

Client Information

Client First Name *

Client Middle Name

Client Last Name *

Client Suffix

Client Phone Number *

Client Address 1 *

Client Address 2

Client City *

Client State *

Client Zip *

Client Email *

Client Date Of Birth *

The Massachusetts 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 *

Gender Of Facility Where Held *

We recognize 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.

Does Your Client Identify As LGBTQIA? *

Ride Information

We are currently only able to post bails for people incarcerated and bailed at the Middleton House of Correction, South Bay House of Correction, Nashua Street Jail, Billerica House of Corrections, Worcester County House of Correction, MCI Framingham, Hampden County House of Correction, Hampden County Jail, and Western Mass. Regional Women's Correctional Facility.

Middleton Transportation: The staff at Middleton HOC will provide transportation to the court that has jurisdiction over the person's case. For example, if the case is being heard out of Salem District Court, the jail will drive the person to Salem District Court once they are released. Because of COVID-19 health and safety concerns, the HOC will not allow families or friends to pick a person up at the HOC. Instead, if there is someone who intends to drive the person home after they are released, they should plan to go to the courthouse the evening bail is being posted.

South Bay House of Correction: MBF cannot provide transportation from the HOC. The HOC will provide $25 in funds to anyone whose case is out of jurisdiction. For example, if the case is being heard out of Plymouth County, the jail will provide $25 in cash for public transportation. Please provide contact information below so that MBF can coordinate with the ride. If the transportation plan is for the jail to provide $25 please let us know below.

Nashua Street Jail: MBF cannot provide transportation from the jail. Please provide contact information below so that MBF can coordinate with the ride. If there is no transportation plan, the person will be released to the street.

Billerica House of Corrections: Billerica does not offer rides to people being released during the 7 pm bail call but the jail will give people a one way train ticket and a ride to the train station. If the person has a prearranged ride, that is most preferred and should be noted in the application.

Worcester County House of Correction: MBF staff/volunteers cannot provide transportation from the HOC. However, MBF will coordinate & pay for Taxi/Ride Sharing transportation for people whose bails we post at the Worcester County House of Correction. If the person has family/friends who can provide transportation, this is preferable. Please let us know the name and contact information for this person so that we may coordinate with them. If the person needs transportation coordinated, please specify this and let us know where they need to be taken.

MCI Framingham: This prison does not offer rides to people being released during the 5 pm bail call. If the person has a ride, that is most preferred and should be noted in the application. MBF in some cases may be able to provide a ride but that needs to be arranged before hand through the application and is not guaranteed.

Ludlow (Hampden County Jail & House of Correction): The HOC will not arrange transportation for those that are released. It is preferred for someone to have a ride/transportation arranged prior to being bailed. For those who do not have transportation arranged, please let us know below and we might be able to arrange for volunteers to give rides but these are not guaranteed.

Chicopee (Western Mass Regional Women's Correctional Center): The HOC will not arrange transportation for those that are released. It is preferred for someone to have a ride/transportation arranged prior to being bailed. For those who do not have transportation arranged, please let us know below and we might be able to arrange for volunteers to give rides but these are not guaranteed.

What Is The Transportation Plan? *

Ride Name *

Ride Relationship *

Ride Phone *

Case Information

Docket No. *

Charges? *

Date Of Arraignment *

Date Of Next Scheduled Appearance *

Will the client be released at the time that bail is posted? If NO, please explain.

Client Released? *

Does the client have any other open cases? If YES, please provide Dockets and Release Status for each case.

Other Open Cases? *

Bail Amount *

Requested Bail Amount *

Who's providing other funds? *

GPS? *

Court Where Charged *

County of Court *

Facility Where Held *

Is your client or loved one experiencing homelessness or precariously housed? If so, is there a specific location they will be returning to? For example, a shelter with a contract/reserved bed, a shelter with overnight intake, a night center, or public area where they stay unsheltered. We understand that it is extremely difficult to arrange and find shelter beds right now, but if this is something that is needed, we will try our best to coordinate.

Experiencing Homelessness? *

Please tell us anything else about the client or their situation you think would be helpful for us to know?

Other Information? *

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