Mississippi
Impact Coalition

A place for justice-impacted people and families to connect, be heard, and find support.

Private & Secure Your submission goes directly to Mississippi Impact Coalition staff. We do not share your information. Use this form for prison conditions, medical concerns, advocacy, reentry support, voting rights, or to stay connected with MIC.

Do not fill this field

01 About You

Your Name *

Your Role *

Phone Number *

Email Address

Mailing Address (optional)

Preferred Contact Method

Phone Call Text Message Email Mail

Seeking parole advocacy?

Our Mississippi Parole Project has a dedicated intake form for parole cases. If you're seeking parole advocacy for yourself or a loved one, please use that form instead.

MPP Intake →

02 Why You're Reaching Out

Check all that apply *

Prison conditions Medical care issues Mental health support Legal assistance (non-parole) Discrimination / civil rights MDOC news & policy updates Family support Reentry support Voting rights restoration Volunteer / advocacy Mailing list / newsletter Other

Based on what you check, we'll ask a few follow-up questions below.

03 Incarcerated Person (If Applicable)

Does this concern someone who is incarcerated?

Yes — loved one Yes — self No

Their Full Name

MDOC Number

Current Facility

Housing Unit / Zone

04 Tell Us More

Prison conditions — specifics

Medical concerns — specifics

Mental health — specifics

Legal needs — specifics

Discrimination / civil rights — specifics

Family support — what would help

Reentry — what's needed

Voting rights — situation

Other — tell us

Anything Else You Want MIC to Know

Everything shared here is confidential.

#MSParoleProject #EndJLWOP #FreedomNow

Mississippi Impact Coalition (formerly Mississippi Prison Reform Coalition) · mississippiimpactcoalition.org

MississippiImpact Coalition

Mississippi
Impact Coalition