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English Protective Order Electronic Application
This form has been modified since it was saved. Please review all fields before submitting.
Steps
1.
Start
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2.
Non-Representation Notice
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3.
Application Information
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4.
Adverse Parties Identification Data
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Start
Bexar County Protective Order Electronic Application
BEFORE YOU BEGIN:
***If you are in IMMEDIATE DANGER please CALL or TEXT 911***
***Please be advised that using any profanity, curse words, foul or vulgar language will result in an error message upon submission and your application will NOT be submitted.*** The application may take over 1 hour to complete. You must complete all sections of this application before submitting.
Please check yes if you understand the above message
*
Yes
What is your First Name?
*
What is your Last Name?
*
What is your Date Of Birth?
*
What is your Date Of Birth?
***The term "Adverse Party" refers to the person you are applying for a Protective Order against***
Adverse Party's First Name
*
Adverse Party's Last Name
*
What is the Adverse Party's Date Of Birth?
Continue
Non-Representation Notice
Protective Order Non-Representation Notice
Please carefully read the following notices about the information you may share during the course of seeking a protective order with the Bexar County Criminal District Attorney’s Office. Once you have read it, check the "I agree…" at the bottom of this page and sign on the signature line. If you have any questions, please ask the Protective Order Unit staff of the Bexar County Criminal District Attorney’s Office.
The Bexar County Criminal District Attorney’s Office represents the State of Texas in this matter. During the course of seeking a protective order, the Assistant District Attorney assigned to your case does not represent you. YOU SHOULD NOT ASSUME THAT AN ATTORNEY-CLIENT RELATIONSHIP EXISTS NOR SHOULD YOU RELY ON ANY VERBAL DISCUSSIONS OR INTERACTIONS WITH THE DISTRICT ATTORNEY TO ASSUME OR CONCLUDE THAT HE OR SHE REPRESENTS YOU PERSONALLY IN THIS OR ANY OTHER MATTER. The Assistant District Attorney assigned to your case does not represent you, but rather, the State of Texas.
The Bexar County Criminal District Attorney’s Office’s appearance in this matter is strictly limited to REPRESENTING THE STATE OF TEXAS in obtaining a family violence, stalking, sexual assault, human trafficking or compelling prostitution protective order under Chapter 85 of the Texas Family Code or Chapter 7A of the Texas Rules of Criminal Procedure. This may include drafting documents, motions, responses, appearing in court, and other legal actions necessary to seek a protective order.
I understand and acknowledge that the Assistant District Attorney assigned to this matter REPRESENTS THE STATE OF TEXAS and that any information I communicate, disclose or share with the Family Justice Center, the Assistant District Attorney assigned to this case, or any person acting on their behalf, is NOT CONFIDENTIAL and may be disclosed during the course of seeking a protective order and to third parties as deemed necessary by the Assistant District Attorney, in his or her sole discretion.
I understand that in representing the State of Texas, the Assistant District Attorney must seek justice and exercise independent judgment and sound discretion. He or she DOES NOT REPRESENT ME and is not required to follow my specific wishes or desires in the handling of this case. I understand that even if I no longer want a protective order or disagree with the handling of my case, the Assistant District Attorney may proceed with seeking an order if he or she decides that to do so serves the interests of justice.
I understand that the role of the Assistant District Attorney is strictly limited to REPRESENTING THE STATE OF TEXAS in seeking a protective order and does not include assistance with any other legal issue. I understand the Office of the Bexar County Criminal District Attorney may prosecute any alleged criminal offense that may become disclosed while describing the same events for which I am seeking to obtain a protective order.
I, the undersigned Applicant, acknowledge and agree that any information I provide to the Bexar County Criminal District Attorney’s Office, its attorneys or staff (referred to in this acknowledgement as "BCDA"), in the process of making an application for a protective order, and in pursuing a protective order is NOT CONFIDENTIAL OR PRIVILEGED. I understand that the BCDA DOES NOT REPRESENT ME. Because of this, I understand there is NO ATTORNEY-CLIENT PRIVILEGE in the information or statements I may provide during the process of seeking a protective order. I understand that the BCDA may use and reveal any information provided, subject to any requirements of law which may make this information exempt from release to the public.
I understand and agree to the above acknowledgment as stated.
*
YES
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Application Information
PROTECTIVE ORDER INFORMATION
It is very important that you answer everything truthfully.
Before submitting this application to the Bexar County Criminal District Attorney’s Office for review, you will be asked to affirm that the information provided in it is true and correct to the best of your knowledge. A person commits the crime of perjury “if, with intent to deceive and with knowledge of the statement’s meaning, he or she makes a false statement under oath or swears to the truth of a false statement previously made, and the statement is required or authorized by law to be made under oath or he/she makes a false declaration.” PROTECTIVE ORDERS are a serious matter. The law limits who is eligible to even apply for one, which includes victims of: domestic violence, family violence, dating violence, human trafficking, stalking, and/or sexual assault. Our office will investigate each application thoroughly and will seek, on behalf of the State of Texas, a protective order for those that qualify based on the law and evidence. Failure to provide the requested information will delay your case and could even result in automatic rejection of your application. Providing the correct legal assistance requires the Bexar County Criminal District Attorney’s Office to be aware of your current legal circumstances, including any pending legal litigation. The following questions are for that purpose.
I understand and agree to the above acknowledgment as stated.
*
Yes
YOUR Information ("Applicant")
Please complete the following fields with YOUR information.
Last Name
*
First Name
*
Middle Name
Maiden
Other Names Used
Sex
*
Age
*
Date Of Birth
*
Current Residence
*
City
*
State
*
Zip
*
County you live in:
*
Is it safe to receive mail at this address?
*
Yes
No
YOUR SAFETY
Please understand that your safety is of the utmost importance to our office. Taking steps to protect yourself from the Adverse Party can be dangerous. In fact, studies show that it is the most dangerous time in an abusive relationship. Help protect yourself by providing contact information that is not accessible to the adverse party.
Best number to contact you?
*
May we contact you via text message?
Yes
No
Safe Email Address
Alternate Safe Email Address
May we contact you via Email?
*
Yes
No
Are you currently employed?
*
Yes
No
Employer
*
Occupation
Work Address
City
State
Zip
Work Phone
Extension
Alternate safe mailing address (should you move from current address)
City
State
Zip
Describe who you are currently living with:
How many children do you have with the Adverse Party?
*
0
1
2
3
4 or more
Does the adverse party know where you are living?
*
Yes
No
Not Sure
Which addresses does he or she know?
Work
Home
School
Child's School
All
None
Please List Two Close Friends Or Relatives Who Will Know How To Get In Touch With You:
Contact 1
Name
Relationship to you
Home Address
Phone Number
Permission for Staff to contact in case of an emergency?
Yes
No
Contact 2
Name
Relationship to you
Home Address
Phone Number
Permission for Staff to contact in case of an emergency?
Yes
No
Pending Legal Proceedings
Do you have any of the following types of cases pending with the adverse party?
Divorce
Child Custody
Child Support
Open Child Protective Service Case
Do you have a Lawyer?
*
Yes
No
If yes, Please list the Lawyers Name and Phone Number:
If you have an open CPS case, Please list the Case Worker's Name and Phone Number:
Who referred you to our office?
*
Attorney
San Antonio Police Department
Bexar County Sheriff's Office
Child Protective Services
Other
If other, Who referred you?
Have you ever applied for a Protective Order prior to today?
*
Yes
No
Was the Protective Order Issued?
Yes
No
Unknown
Has a Protective Order ever been issued against you?
*
Yes
No
Unknown
If yes, what year and in what County was the Protective Order issued:
Do you have any pending criminal charges?
*
Yes
No
Unknown
Are you currently on Pre-Trial Diversion in Bexar County?
*
Yes
No
Unknown
Are you currently on Probation or Parole?
*
Yes
No
If yes, which one?
Probation
Parole
Military
Are you currently on active duty in the U.S. Armed Forces?
*
Yes
No
Are you currently a member of the State Military Forces (Texas Army National Guard, Texas Air National Guard, or Texas State Guard)?
*
Yes
No
FOR STATISTICAL PURPOSES ONLY
Gender
*
Male
Female
Other
If other, Gender Identification
Your Average Monthly Income:
*
Your Level Of Education
*
Indicate your race or ethnicity
*
Hispanic
Asian
White, Non-Hispanic
Black, Non-Hispanic
Other
If Other, Please specify
Information About Your Relationship:
What is your relationship to the adverse party?
*
Dating
Spouse
Common - Law Spouse
Ex - Spouse (divorced)
Ex - Boyfriend
Ex - Girlfriend
Currently live together
Previously lived together
Biological parents of the same child(ren)
Son
Daughter
Mother
Father
Brother
Sister
Not Related
Other, describe below
Describe "Other" relationship:
For the District Attorney's Office to assess your case, we need to understand the nature of the violence that happened to you and / or your child(ren). Please answer the following questions to the best of your knowledge:
Has the Adverse Party ever done any of the following to you? Please check all that apply.
*
Pushed, pulled or shoved
Pulled your hair
Scratched you
Twisted your arm
Hit you with his/her hand
Hit you with an object
Slapped you
Kicked or stomped on you
Bit you
Pinched you
Cut you
Burned you
Stalked (followed) you
Controlled most of your daily activities
Was jealous/controlling
Hit or hurt you while you were pregnant
Spied on you
Confined you against your will
Prevented you from seeking medical treatment
Prevented you from taking medication
Threatened you with a Gun/Firearm, knife or other weapon
Shot at you
Thrown objects at you or hit you with an object
Tried to choke, strangle or restrict your breathing in any way
Threatened to hurt you
Threatened to kill you
Threatened to hurt your children
Threatened to kill your children
Threatened to hurt/kill a family pet
Hurt/killed a family pet
Violent with you in front of your children
Forced or attempted to force you to have sex
Threatened to cut you off from financial support
Broken into your residence
Damaged your property
If you answered yes to the adverse party has threatened you with a weapon. What type of weapon was used?
Gun / Firearm
Knife
Other
Which period of time best describes how long ago you were threatened with the weapon:
1 to 3 days ago
1 month or less
6 months or less
6 months to 1 year
1 year or more
If you answered yes to threatened to kill you or a family member, which period of time best describes how long ago?
1 to 3 days ago
1 month or less
6 months or less
1 year or less
1 year or more
If you answered yes to the adverse party has tried to choke, strangle, or restrict your breathing in any way, which period of time best describes how long ago?
1 to 3 days ago
1 month or less
6 months or less
1 year or less
1 year or more
If you answered yes to the adverse party hit or hurt you while you were pregnant, what period of time best describes how long ago?
1 to 3 days ago
1 month or less
6 months or less
1 year or less
1 year or more
If you answered yes to the adverse party forced or attempted to force you to have sex, what period of time best describes how long ago?
1 to 3 days ago
1 month or less
6 months or less
1 year or less
1 year or more
How long have you known the adverse party?
Less than 1 year
More than 1 year
More than 5 years
More than 10 years
If you lived with the adverse party, what period of time best describe how long you lived together?
Less than 1 year
More than 1 year
More than 5 years
More than 10 years
***Please be advised that using any profanity, curse words, foul or vulgar language will result in an error message upon submission and your application will NOT be submitted. *** Starting with the most recent incident, please indicate all of the incidents of violence you have experienced. This should include those that are not very recent and those that did not involve law enforcement. Please give the month, day and year of each incident and explain what the adverse party did. A general period is sufficient if you do not remember the exact dates. Do the same if the violence occurred constantly over a period of time, and you cannot recall a specific incident. Please document the long-term abuse and give the frequency with which it happened. Please note if there are police reports and give case numbers if they are available.
PLEASE DESCRIBE THE VIOLENCE IN YOUR OWN WORDS
*
Date of Last Incident
Address of Last Incident (if you recall)
Was the adverse party arrested?
*
Yes
No
Police Report Number
Which police agency responds to your home?
*
SAPD
Sheriff
Other
If other, please specify
Are you aware of any pending criminal charges related to the incident listed above?
*
Yes
No
Unknown
Do you know the case number or numbers?
If charges are pending, please list the charges below?
Do you currently have any visible injuries? (Examples: bruises, scratches)
*
Yes
No
If yes, please describe the injuries:
Was a Magistrate’s Emergency Protective Order issued against the adverse party?
*
Yes
No
Unknown
If you have additional Police Report Numbers or Case Numbers you would like to include, Please list below:
Information About Your Children and People Who Live with You Now
Please list your children (whether or not they live with you). Please also list ANYONE who lives with you.
Person 1
Name
Relationship to YOU
Date Of Birth
Age
School / Daycare Name
School/Daycare Address
IS THIS ADDRESS CONFIDENTIAL?
Yes
No
Has this person been assaulted / threatened OR witnessed violence?
Yes
No
Do you want to include this person on the protective order?
Yes
No
Is this person the abuser's biological child?
Yes
No
Person 2
Name
Relationship to YOU
Date Of Birth
Age
Daycare/School Name
Daycare/School Address
IS THIS ADDRESS CONFIDENTIAL?
Yes
No
Has this person been assaulted / threatened OR witnessed violence?
Yes
No
Do you want to include this person on the protective order?
Yes
No
Is this person the abuser's biological child?
Yes
No
Person 3
Name
Relationship to YOU
Date Of Birth
Age
Daycare/School Name
Daycare/School Address
IS THIS ADDRESS CONFIDENTIAL?
Yes
No
Has this person been assaulted / threatened OR witnessed violence?
Yes
No
Do you want to include this person on the protective order?
Yes
No
Is this person the abuser's biological child?
Yes
No
Person 4
Name
Relationship to YOU
Date Of Birth
Age
Daycare/School Name
Daycare/School Address
IS THIS ADDRESS CONFIDENTIAL?
Yes
No
Has this person been assaulted / threatened OR witnessed violence?
Yes
No
Do you want to include this person on the protective order?
Yes
No
Is this person the abuser's biological child?
Yes
No
Person 5
Name
Relationship to YOU
Date Of Birth
Age
Daycare/School Name
Daycare/School Address
IS THIS ADDRESS CONFIDENTIAL?
Yes
No
Has this person been assaulted / threatened OR witnessed violence?
Yes
No
Do you want to include this person on the protective order?
Yes
No
Is this person the abuser's biological child?
Yes
No
Person 6
Name
Relationship to YOU
Date Of Birth
Age
Daycare/School Name
Daycare/School Address
IS THIS ADDRESS CONFIDENTIAL?
Yes
No
Has this person been assaulted / threatened OR witnessed violence?
Yes
No
Include this person on the protective order?
Yes
No
Is this person the adverse parties biological child?
Yes
No
Who has physical custody of the children listed above?
Who has legal custody of the children listed above?
Do you want the adverse party to visit the children?
Yes
No
If no, briefly explain
Child Exchange
If the protective order is granted you may need to designate someone to coordinate the exchange of children. Please identify a person (third-party) who you are comfortable "having do this for you".
Name and Phone Number of the person you wish to designate:
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Adverse Parties Identification Data
IDENTIFICATION DATA FOR SERVICE OR TCIC/NCIC ENTRY FOR PROTECTIVE ORDERS
Please complete the following questions with the Adverse Parties Information (The person you are seeking a Protective Order against).
Name
*
Date Of Birth
Alias
Phone Number
*
Alternate Phone Number
Current Address:
*
City
*
State
*
Zip
*
SID Number
Sex
*
Race
*
Height
Weight
Hair Color
Eye Color
In the Adverse Party currently employed?
*
Yes
No
Employer
*
Employer's Address
*
Alternate Address for the Adverse Party
For a Temporary Protective Order to be enforceable, the Adverse Party must be must be “served” before he or she can be charged with the crime of violating the protective order. Service is also necessary for you to receive a Final Protective Order from a judge. If the Adverse Party cannot be located at the addresses you listed above, what are some other places he or she may be found?
Alternate Address 1
If known, please include the days of the week and times when the Adverse Party may be found at this location.
Alternate Address 2
If known, please include the days of the week and times when the Adverse Party may be found at this location.
Alternate Address 3
If known, please include the days of the week and times when the Adverse Party may be found at this location.
Vehicle Make & Model
License Plate
Year of Vehicle
Color of Vehicle
To the best of your knowledge does the Adverse Party:
Own or possess weapons or firearms?
*
Yes
No
Unknown
If yes, briefly explain the type of weapon owned or possessed
Does the adverse party have warrants?
*
Yes
No
Unknown
Does the adverse party use illegal drugs or drink alcohol excessively?
*
Yes
No
Unknown
Does the adverse party have a history of mental illness?
*
Yes
No
Unknown
If yes, briefly explain
*
Has the adverse party ever threatened or attempted to commit suicide?
*
Yes
No
Unknown
If yes, Which period of time describes the last threat or attempt?
1 to 3 days ago
Less than 1 month
Less than 6 months
More than 6 months
More than 1 year
Does the Adverse Party have pending Criminal Charges in Bexar County?
*
Yes
No
Unknown
Is the Adverse Party on Pre-Trial Diversion in Bexar County?
*
Yes
No
Unknown
Is the Adverse Party on Probation or Parole?
*
Yes
No
Unknown
If yes, select one
Probation
Parole
Is the Adverse Party currently on active duty in the U.S. Armed Forces?
*
Yes
No
Unknown
Is the Adverse Party a member of the State Military Forces (Texas Army National Guard, Texas Air National Guard, Coast Guard, or Texas State Guard)?
*
Yes
No
Unknown
If yes, Which branch of the Military?
If yes, provide the commanding officers name and military base location:
Applicant Information
I understand that the respondent MUST be served for the Temporary Protective Order to be valid. I hereby give permission for Law Enforcement to contact me if there is additional information required for service purposes.
If you understand type your First and Last Name below:
*
Permission to contact
*
Yes
No
Please provide a SAFE phone number for Law Enforcement and the District Attorney's Office to contact you
*
Did you receive assistance filling out this form?
*
Yes
No
If YES, please list this name of the person who assisted you
*
***Please be advised that using any profanity, curse words, foul or vulgar language will result in an error message upon submission and your application will NOT be submitted. ***By pressing submit your application will be sent to the Bexar County District Attorney's Office, Protective Order Unit. Please verify you have given an accurate phone number. Once the application has been received someone will contact you by telephone during normal business hours (Monday - Friday 8 am - 5 pm) to explain the protective order process. Should you have further questions call 210.631.0100 or visit the Contact Us page on our website.
Contact Us
https://bexarcountyprotectiveorders.org/contact-us
Further Instruction
***If you are in IMMEDIATE danger please CALL or TEXT 911***
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
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