Student Legal Services Intake Form
This form will help Student Legal Services determine whether you are eligible to use our services. Any responses you give in this form will be kept CONFIDENTIAL. This form is for new issues; If you already have an open case with an attorney, please return to and choose "Request a Follow-Up Appointment."
Your answer
Full Name *
Last, First, Middle Initial
Your answer
Gender *
Address *
Ex: 42 Wallaby Way, Apt 9
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Date of Birth *
Tap year to select year of birth
Year in School *
Your answer
Cell Phone Number *
Format: 555-555-5555
Your answer
Email Address (Your attorney will use this address to communicate with you) *
Your answer
May we leave a voicemail if necessary? *
Are you a U.S. Citizen? *
Would you like to add a permanent address different from your current address? *
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