Applying for a Public Defender

Applying for a Public Defender

Delaware County, Pennsylvania
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.
Name*

First NameLast Name
Name as it Appears on Court Documents
Leave this blank if it is the same as the name provided.
MaleFemaleNon-BinaryTransgenderOther
YesNo
Language Spoken*
Please enter the language you'll need interpretation assistance for.
Date of Birth*

MonthDayYear
Date
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*

Confirmation Email
Court Information

All fields below are optional, however providing the information from your court documents will make reviewing your application both faster and easier.
YesNo
OTN
The OTN number can be located on your docket sheets as well as complaint and affidavit.
YesNo
Upcoming Court Date*

MonthDayYear
Date
Time MinutesAM/PM Option
Court Location
Docket Format
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.
MJ-District Court Number-CR-Case Number-Case Year
District Court Number
Please enter your case's magisterial district court number.
Case Number
Please enter your case's magisterial case number.
Case Year
Please enter your case's year.
CP-23-CR-Case Number-Case Year
Case Number
Please enter your case's common pleas case number.
Case Year
Please enter your case's year.
Financial Information

Financial information is required to help qualify you for representation with the Public Defender's Office.
YesNo
Where do you work?*
Household Income*
Rate of Payment*
Number of Dependents
Please include yourself when determining the number of dependents in your household.
Other Assets/Income (ex. Social Security, Disability, etc.)
List any other assets you own or income you receive, separated by comma.
Affidavit

Please read and respond carefully to the questions below.
YesNo
YesNo
Confirmation Signature*

Clear
Please verify that you are human*
Should be Empty:

Applying for a Public Defender

Court Information

Financial Information

Affidavit