Client Intake Form
These services are only available to non-Legal Aid of NC eligible applicants. Only complete this form if you have confirmed that you are not eligible for Legal Aid of NC (1-866-219-5262).

Please fill out this form if you are not eligible for Legal Aid of North Carolina's services and would like to request help from a volunteer lawyer for COVID-19 or Hurricane Florence related legal issues:


Questions? Email help@ncprobono.org
Personal Information
1. First Name *
2. Last Name *
3. Phone Number *
4. Email Address *
5. Street Address (Mailing Address) *
6. City (Mailing Address) *
7. County of Residence *
8. Preferred Method of Contact *
If phone is your preferred method of contact, please make sure your phone voice mail is set up and your mailbox is not full so we will be able to reach you.
9. Does the phone number above accept text messages? *
10. If you have a back-up number you would like to provide, please do so here. (If this phone belongs to someone else, please list their name and relationship to you.)
11. Area of legal help requested *
12. Please describe your legal problem in detail: *
The NC Pro Bono Resource Center helps people when they are unable afford legal help, when they lack access to legal services, or for other compelling public interest reasons.
13. Which of the following applies to you? *
If you select Other below, please describe why you need help with your case and for what important reasons.
Required
Demographic Information
To help the NC Pro Bono Resource Center better understand our clients and their circumstances, we are asking the following demographic questions.
14. Annual Household Income *
15. Number of Adults in Household *
Please list the number of adults living in your household including yourself and other adults.
16. Number of Children in Household *
Please list the number of children (below the age of 18) living in your household.
17. Number of Dependents in Household *
Anyone in your household that you provide more than half of their financial support, including children or other relatives are considered dependents for the purposes of this question.
18. Race *
19. Gender *
20. Are you a veteran? *
Date of Birth
MM
/
DD
/
YYYY
21. Age *
22. Disability (within household) *
23. Education Level *
24. How did you hear about the NC Pro Bono Resource Center? *
Client Agreement
By submitting this form, you understand and agree to the following statements below.
By filling out this form I am requesting to be connected with a pro bono lawyer. I understand that as part of the project, the Pro Bono Resource Center will strive to match me with a pro bono attorney within one week. *
I understand that I may not receive a pro bono attorney through this process. Note: The Pro Bono Resource Center will contact you to let you know whether we can find a pro bono attorney for you. *
There is no cost for this service. *
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