Application for Legal Assistance from ArchCity Defenders, Inc.
Please complete the following application to the best of your ability. Any information left out or not provided could delay the review of your application and our determination as to whether we can and will be able to provide you with legal assistance.

Please Note:

*Unfortunately, the large number of requests for assistance and our limited resources mean we cannot accept for legal assistance every case or legal issue that is submitted to our office.
*You should not assume we will be able to help you.
*You are still responsible for all legal obligations or deadlines regarding your issue while we review your application.
*Completing an application with ArchCity Defenders does not make you a client and does not create an attorney-client relationship.
*We review the applications as they come in and will respond by mail to the address you provided to our office within 7-10 business days.

A printable copy of our application that you can complete and email, mail, or deliver to our office is available on our website at www.archcitydefenders.org

If you would like assistance in completing the application, please email us at intake@archcitydefenders.org, contact our office at (314) 361-8834, or visit our office Monday through Thursday between 9 a.m. and 5 p.m. or Friday between 9 a.m. and 12 p.m.

**ArchCity Defenders, Inc. and its agents are not your lawyers and have not agreed to represent you in any of your legal matters. Once you submit your application, we will review and determine whether we can and will provide you with legal assistance. In receiving your application, ArchCity Defenders, Inc. is not agreeing to represent you in any legal matter.

Full Name (First Name, Middle Name, and Last Name) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Social Security Number (if applicable)
Your answer
Address *
Your answer
Where you receive mail if it is different from your address.
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Is it safe to leave you a message at that phone number? *
Do you have any alternate phone numbers where we can reach you?
Your answer
Is it safe to leave you a message at the alternate number(s)?
Email Address
Your answer
Drivers License Number (If applicable)
Your answer
Race *
Gender Identity *
Pronoun *
Ethnicity *
Are you a United States Veteran? *
Primary Language *
Marital Status *
Where do you stay? *
Required
If you stay somewhere other than your own home or a home that you rent, please state the location:
Your answer
Do you have a caseworker at a St. Louis-area social service agency or provider? *
If you do have a caseworker at a St. Louis-area social service agency or provider, please provide us with the agency's name and the caseworker's name.
Your answer
Reason Requesting Legal Assistance (check all that apply) *
Required
Opposing Party/Government/Person/Company on the other side of the case(s) or legal matter(s) (if known)
Your answer
Brief Description of Legal Matter *
Your answer
Do you have a court date? *
If you have a court date, please list the date and location.
Your answer
Do you have any case numbers? *
If you have case numbers, please list them below.
Your answer
Number of Children in Your Household that You Financially Support *
Your answer
If applicable, please list the children in your household, including full name, date of birth, and gender identity.
Your answer
Number of Adults in Your Household that You Financially Support *
Your answer
If applicable, please list the adults in your household, including full name, date of birth, and gender identity.
Your answer
Monthly Income - list amount and source and include all sources of income, i.e. employment, food stamps, TANF, disability, child support, pension (if you have no income, please answer "none".) *
Your answer
Assets - list the amount of money you have in cash or in a checking or savings account (if you have no assets in this category, please answer "none".) *
Your answer
Assets - list real property (the property you own but cannot move, i.e. land/buildings/real estate) (if you have no assets in this category, please answer "none".) *
Your answer
Assets - list personal property (the property you own and can move) (if you have no assets in this category, please answer "none".) *
Your answer
Initial here that you understand that ArchCity Defenders, Inc. and its agents are not your lawyers and have not agreed to represent you in any of your legal matters. You understand that you are not a client of ArchCity Defenders, Inc. and will not be unless it accepts your case for representation and you meet with and complete written retainer documents with an attorney from ArchCity Defenders, Inc. *
Your answer
Initial here that you understand that because you are not a client, ArchCity Defenders, Inc. and its agents are not responsible for ensuring any statute of limitations requirements are met in your case or any court deadlines are met in any currently pending case or other legal proceeding you may have while your request for assistance is pending with our office. *
Your answer
Initial here that you authorize ArchCity Defenders, Inc. and its agents to obtain driving records, conduct warrant checks, search case records, and/or request any other documentation or information needed to process your request for legal assistance. You also grant ArchCity Defenders, Inc. and its agents permission to communicate with your referring caseworker/agency to the extent necessary to complete the application process, if applicable. *
Your answer
Initial here that the information you provided in this application is true to your best knowledge and belief. *
Your answer
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