BCJ Free Legal Clinic Intake Form
Name *
Pronouns
We want to do our best to help you! In order for us to process your intake, you must supply us with some form of contact information - either email address, telephone number, or address. We will evaluate your intake and get back to you. Submitting an intake form does not create an attorney-client relationship. All intakes are confidential. *
Do you need a language interpreter? If yes, which language?
Address
Mailing Address (if different)
Telephone Number
May we leave a voicemail at this number?
Clear selection
Email Address
Date of Birth
MM
/
DD
/
YYYY
Age
Ethnicity
Income (specify weekly, monthly, or yearly)
Property owned
Debt
Bank accounts, CDs, stocks, etc.
Do you need food or pet food assistance?
Clear selection
Do you experience any of the following abuse issues at home?
Please briefly describe your legal situation and any time deadlines (court appearances) coming up
Who is the opposing party?
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