Family Law Application |

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Please answer all questions to the best of your ability

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1. INFORMATION ABOUT YOURSELF

Your Name(Required)

First Middle Last

Date of birth(Required)

Which town or city do you live in?(Required)

Our funder requires that we ask if you are a U.S. Citizen. You can still receive help even if you are not a citizen.(Required)

Yes, I am a U.S. Citizen

No, I am Legal Permanent Resident

I am not a U.S. Citizen or Permanent Resident

Please enter your name and date of birth to confirm that you are a U.S. Citizen(Required)

DO YOU HAVE A COURT DATE IN THE NEXT TWO MONTHS?(Required)

Yes

No

WHEN IS YOUR NEXT COURT DATE?

Is it safe to send mail to the address or call the number on your Application for Legal Services?(Required)

Yes

No

Safe Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Safe Telephone Number

Safe Email Address

2. INFORMATION ABOUT THE PERSON YOUR CASE IS AGAINST

Their Relationship to you (spouse, parent, child, parent of your child[ren])

Their Name(Required)

First Middle Last

Their Former/Maiden/Alias Name

Their Date of Birth (if known)

Their Gender

Their Pronouns

Their Language

Their Ethnicity

Their Place of Birth

Their Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Their Home Phone

Their Work Phone

Their Mobile Phone

Where are they employed? (if you know)

Current Job Title

Income/salary

Is this person represented by an attorney?

Yes, and I know the attorney's name

Yes, but I do not know the attorney's name

No or I don't know

Attorney's Name (If you know)

3. INFORMATION ABOUT YOUR RELATIONSHIP WITH THE PERSON YOUR CASE IS AGAINST

When did the relationship begin?

When did it end?

Are you married to this person?(Required)

Yes

No

Are there any children involved in this case?(Required)

Yes

No

Did you ever live with the other person?

Yes

No

When did you first live together?

Where?

When did you last live together?

Where?

How many children does the other person have (including your children together)?

Names and Ages of other person's children (if different from your children)

4. MARRIAGE AND ASSETS

Date of Marriage

Date of Divorce (if divorced)

Do you and/or your spouse own a home or land?

Yes

No

Where is the home/land located?

When was the home purchased?

Do you and/or your spouse own any other assets? (for example, retirement accounts, cryptocurrency, cars, boat/RV, stocks, etc.)

Yes

No

Please describe the other assets that you own:

Do you and/or your spouse own a business?

Yes

No

Please state the name, location, and describe the nature of the business

6. WHAT ARE YOUR LEGAL GOALS?

You are requesting legal representation. If you could eventually get a court order that said exactly what you wanted, what would the court order say regarding issues of protection from abuse, child support, custody, visits, your home, etc.? In other words, what are your goals?

Your Goals(Required)

7. INFORMATION ABOUT COURT MATTERS

Do you currently, or have you had in the past, a restraining order against the other person?

Yes

No

If yes, from which Court?

When is the next hearing date?

Does the other person have, or have they had in the past, a restraining order against you?

Yes

No

If yes, from which Court?

When is the next hearing date?

Are there any other Court matters involving you and the other person?

Yes

No

I don't know

Please explain the other Court matters:

Have you ever been arrested?

Yes

No

Please list your charge(s) and date(s)

8. IF THE OTHER PERSON HAS ABUSED YOU, PLEASE COMPLETE THIS SECTION

The next section contains questions about abuse. If that is present in your case, it may be necessary to discuss that with your advocate and with the Court. We understand it may be difficult or uncomfortable to discuss. Please complete the answers as thoroughly as it is safe for you to do so.

Has the other person ever abused you?(Required)

Yes

No

Describe the first incident of abuse. When was it and what happened?

This field requires an entry. Write "not applicable" or n/a if there have been no incidents.

Describe the worst incident of abuse. When was it and what happened?

This field requires an entry. Write "not applicable" or n/a if there have been no incidents.

Describe the most recent incident of abuse. When was it and what happened?

This field requires an entry. Write "not applicable" or n/a if there have been no incidents.

Did you file a police report for any of the incidents above?

Yes

No

If yes, are you able to provide us a copy?

Yes

No

9. CONCLUSION

Who referred you to us?

If we cannot accept your case, may we refer it to another agency?

Yes

No

Type your name to sign the application

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Family Law Application