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Application Form

Apply for a Public Defender
Complete and submit the form below to apply for a public defender. Applications are reviewed before determination is made, so please be aware of your application status. You can call our office at 610-891-4100 for an update on your application or visit us at 220 N Jackson St., Media, PA 19063 Mondays - Fridays between the hours of 8:30 AM and 4:30 PM.
Leave this blank if it is the same as the name provided.

Court Information

All fields below are optional, however providing the information from your court documents will make reviewing your application both faster and easier.
The OTN number can be located on your docket sheets as well as complaint and affidavit.
Please select the court location your case is scheduled for. Your court location and judge are listed on the summons you've received. Please note: there may be some variation in judge, but not location.
Please select the correct case docket format for your case and enter the docket number in the fields below. You can find your docket number on any of your court paperwork.
As you begin entering the docket number, you'll see a preview of your docket to verify your case's docket number.
Auto-Generated Preview

Financial Information

Financial information is required to help qualify you for representation with the Public Defender's Office.
Please include yourself when determining the number of dependents in your household.
List any other assets you own or income you receive, separated by comma.

Affidavit

Please read and respond carefully to the questions below.
Please print your full name. It will be considered as your signature.