BCJ Free Legal Clinic Intake Form
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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?
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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?
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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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