To be completed by all AJC members requesting assistance

This form is to be used for any questions or representation requests to the AJC. In order to serve you better, we ask that you first consult our FAQs and then your regional Governing Council representative, where applicable, before completing and forwarding an intake form to the AJC. Thank you.

Are you a Registered Member of the AJC? If not, you must complete and submit a membership form prior to receiving assistance from the AJC.

SECTION 1 – Personal Information
SECTION 2 – Intake Summary
SECTION 3 – Actions