Conflicts Check Form
If you would like to submit your case to be reviewed by our legal staff for possible legal assistance or appellate representation, the first step is to complete this Conflicts Check Form. If you do not have a safe email address where we can reach you, please call us at (510) 858-7358 to complete this process with us by phone.

Complete this form only if you meet all of the following 3 requirements:
1. I am a survivor of domestic violence and/or intimate partner abuse.
2. I have a family court or civil court order I want to appeal, or I am defending against an civil appeal.
3. The order I want to appeal was issued by a California court, and is less than 1 year old.

If you do not meet all 3 requirements, we have other resources available that may help you. Please return to the previous page and select the the button that says "No, but I still need help."


FVAP provides free legal help and attorney representation in appellate court to survivors of domestic violence or intimate partner abuse who need assistance with appeals cases. We are a small nonprofit, so unfortunately we cannot help everyone who requests our assistance.

Complete and submit the form below. Someone from FVAP will contact you within 1-2 business days for more information about your case.

Your First Name: *
Your answer
Your Last Name: *
Your answer
Any aliases (Other names you go by, or have gone by in the past, including maiden names):
Your answer
Opposing party First Name: *
Your answer
Opposing party Last Name: *
Your answer
Any aliases (Other names the opposing party goes by, or has gone by in the past, including maiden names
Your answer
The names of any children or other parties involved in the case:
Your answer
How did you hear about us? (For example: internet, word of mouth, another organization.) If you were referred to us by another organization, please tell us the organization’s name: *
Your answer
Safe email address where we can reach you:
Your answer
Safe phone number where we can reach you:
Your answer
Check one: *
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