Caption and notice
The district and division, the full names of the plaintiffs and defendants without addresses, and a case number left for the Clerk's Office. Page 1 has a notice on privacy, exhibits and the filing fee.
Pro Se 14
Complaint for Violation of Civil Rights (Prisoner)
- Agency
- U.S. Courts
- Revision
- Rev. 12/16
- Fillable fields
- 125
- Pages
- 11
- Official source
- U.S. Courts form page
- Checked
- October 20, 2026
Pro Se 14: Complaint for Violation of Civil Rights (Prisoner)
Pro Se 14, Complaint for Violation of Civil Rights (Prisoner), is a pleading form from the U.S. Courts for a case in a United States district court. It is one of the Civil Pro Se Forms, which the U.S. Courts page says are limited to types of cases often filed in federal courts by people who represent themselves or who may not have much experience in federal courts.
The 11-page form is titled a Prisoner Complaint. It asks for the parties, whether the suit is against federal officials (a Bivens claim), state or local officials (a § 1983 claim) or both, prisoner status, the facts, injuries, relief, exhaustion of administrative remedies, previous lawsuits, and a signed certification under Federal Rule of Civil Procedure 11.
The U.S. Courts offers it as a PDF and a Word file, effective on December 1, 2016. This page explains the form in plain words and is not legal advice. You can fill it out free in your browser on this page and download the result without an account.
What's on Pro Se 14
I. The Parties to This Complaint
For each plaintiff: name, other names used, ID number, current institution and address. For up to four defendants: name, job or title, shield number, employer, address and capacity.
II. Basis for Jurisdiction
Whether federal officials (Bivens), state or local officials (42 U.S.C. § 1983) or both are sued, the rights claimed to be violated, and how each defendant acted under color of state, local or federal law.
III to VI. Status, claim, injuries and relief
Prisoner status, the facts with where, when and how each defendant was involved and no case or statute citations, any injuries and medical treatment, and the relief asked for with amounts of any damages.
VII. Exhaustion of Administrative Remedies
Questions about the facility's grievance procedure, any grievance filed, its result and appeals. The form quotes the Prison Litigation Reform Act, 42 U.S.C. § 1997e(a), and says a case may be dismissed if administrative remedies were not exhausted.
VIII and IX. Previous lawsuits and closing
Whether a case was dismissed under the "three strikes rule" of 28 U.S.C. § 1915(g), other lawsuits on the same facts or on prison conditions, then the Rule 11 certification and signatures.
How to fill out Pro Se 14
- 1
Read the notice on page 1
Page 1 cites Federal Rule of Civil Procedure 5.2: a filing may include only the last four digits of a Social Security number, the year of birth, a minor's initials and the last four digits of a financial account number.
- 2
Name each defendant the same way twice
Write each defendant's full name in the caption without addresses, then list the same defendants in Section I.B and check individual capacity, official capacity or both.
- 3
Mark Bivens, section 1983 or both
Section II asks which officials are sued and, for each type, the rights claimed and how each defendant acted under color of state, local or federal law.
- 4
State the facts briefly
Section IV asks for the facts, dates, times and locations and how each defendant was personally involved, with no cases or statutes cited. Several claims are numbered in separate paragraphs.
- 5
Answer the grievance and lawsuit questions
Sections VII and VIII ask about grievances and their results, any "three strikes" dismissal, and earlier lawsuits, using the same 7 questions for each lawsuit. Grievance documents may be attached as exhibits.
- 6
Sign and date
Sign under the Rule 11 certification. A plaintiff without an attorney adds a prison identification number and prison address and agrees to keep the address current with the Clerk's Office.
Why fill Form Pro Se 14 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the U.S. Courts, not a copy someone retyped
- Works on a phone, tablet or computer
Court, fee and what the form warns about
Court
The form is captioned for a United States District Court, district and division. The page says to consult the rules and caselaw that govern in the court where the pleading is filed.
Filing fee
The form says that for the complaint to be filed, it must be accompanied by the filing fee or an application to proceed in forma pauperis. It does not print the fee amount.
Exhaustion
The form quotes 42 U.S.C. § 1997e(a) on exhausting available administrative remedies before an action about prison conditions, and says administrative remedies are also known as grievance procedures.
Three strikes rule
The form quotes 28 U.S.C. § 1915(g), which it says bars a prisoner with three or more earlier dismissals on the listed grounds from suing or appealing without paying the filing fee, unless under imminent danger of serious physical injury.
Exhibits
Except as noted in the form, it says the plaintiff need not send exhibits, affidavits, grievance or witness statements, or other materials to the Clerk's Office with the complaint.
A lawyer
The page says that if you are not a lawyer and are suing or have been sued, it is best to have or consult a lawyer if possible.
Related forms
AO 240
Application to Proceed in District Court Without Prepaying Fees or Costs (Short Form)
28 fields, 2 pages
AO 239
Application to Proceed in District Court Without Prepaying Fees or Costs (Long Form)
191 fields, 5 pages
Pro Se 15
Complaint for Violation of Civil Rights (Non-Prisoner)
82 fields, 6 pages
Pro Se 1
Complaint for a Civil Case
76 fields, 5 pages
AO 440
Summons in a Civil Action
34 fields, 2 pages
Who uses Pro Se 14?
The page describes the Civil Pro Se Forms as examples for people who represent themselves or have little experience in federal courts, and says to use the form that fits your case. The form names these parties.
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Questions about Form Pro Se 14
Is Pro Se 14 legal advice?
No. The U.S. Courts page says no form provides legal advice or substitutes for having or consulting a lawyer, and that following a form does not guarantee a pleading is legally or factually correct or sufficient.
What are the Bivens and section 1983 boxes on the form?
The form says that under 42 U.S.C. § 1983 a person may sue state or local officials, and under Bivens v. Six Unknown Named Agents of Federal Bureau of Narcotics, 403 U.S. 388 (1971), federal officials for the violation of certain constitutional rights. Section II.A has a box for each.
What is the three strikes rule on the form?
The form quotes 28 U.S.C. § 1915(g) and asks whether, to the best of your knowledge, a case of yours was dismissed under it. If yes, it asks which court and when, and for a copy of the order if possible.
Why does the form ask about grievances?
Section VII quotes the Prison Litigation Reform Act, 42 U.S.C. § 1997e(a), and says a case may be dismissed if administrative remedies were not exhausted. It asks about the grievance procedure, any grievance filed and any appeal.
Are exhibits sent with the complaint?
The form says that, except as noted in it, the plaintiff need not send exhibits, affidavits, grievance or witness statements, or other materials. Section VII notes that documents about exhaustion of administrative remedies may be attached as exhibits.
What personal details does a complaint leave out?
The notice on page 1 cites Federal Rule of Civil Procedure 5.2: no full Social Security number or full birth date, no full name of a person known to be a minor, and no complete financial account number.
Is there a version for people who are not prisoners?
The U.S. Courts forms include Pro Se 15, Complaint for Violation of Civil Rights (Non-Prisoner). This page cannot say which form fits a case.