Scranton Road Legal Clinic Intake Form
All participants must complete an intake form in order to receive legal advice from an attorney. Please complete the form below and you will receive a follow-up call from one of our attorneys. Please note that we are only able to serve those residing in Cuyahoga County, and cannot assist you if you are currently represented by legal counsel. Thank you!
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
Sex *
Address *
Please note that we are not able to provide services outside of Cuyahoga County.
Your answer
City/State/Zip *
Your answer
Phone *
Your answer
Your answer
Race/Ethnicity (Check all that apply)
Best Way to Reach You
Household Size
Please indicate the number of adults and the number of children living in your household.
Your answer
Are you the parent or guardian of a CMSD Student?
If yes, what school(s) do(es) your child(ren) attend?
Your answer
Annual Household Income *
Source of Income
What type of legal issue do you have? *
Are you currently being represented by an attorney in this matter? *
Please note that due to ethical considerations, we are unable to advise you if you are engaged in representation with another attorney.
Are you in need of a translator or interpreter? *
If so, what language do you speak?
Your answer
Is your case currently pending, or has a case already occurred?
If Yes, please list any court dates and/or case numbers you have below.
Your answer
Do you currently see a case manager/social worker?
If yes, can we speak with them regarding your case if necessary?
Are you in immediate danger of abuse, eviction, or arrest? *
How did you find out about Scranton Road Legal Clinic?
Participant Acknowledgement *
I understand that attorneys are available for brief advice and referral only. No attorney-client relationship or promise to perform legal services exist between myself and Scranton Road Legal Clinic. I understand that the attorney will not be representing me for my case. The purpose of this Brief Advice Session is to better understand my situation so I can make an informed legal decision. I may receive a referral to an outside attorney, nonprofit, or social services agency. I am under no obligation to contact any referrals given. I am free to seek legal assistance outside of Scranton Road Legal Clinic. I agree to provide the true, complete and accurate information needed for the evaluation of my case. By checking below, I hereby authorize that my information be released to volunteers and staff of the Scranton Road Legal Clinic and/or other outside professional(s) for the purpose of obtaining effective strategies or soliciting professional opinions that can be helpful to my case. By checking below, I acknowledge that I have read and understand this Acknowledgement and agree to its terms.
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