Snohomish County Legal Services Client Intake
Please complete and submit this intake within 7 days so that we may determine your eligibility for services.. After we receive the completed intake, we will contact you regarding an appointment. If we do not hear from you within 7 days, we will assume that you are not interested in using our services.  Please note - completing this intake does not establish an attorney-client relationship and does not guarantee you services. ALL ANSWERS ARE STRICTLY CONFIDENTIAL.
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Last Name *
First and Middle Name *
Are you getting ready to file for Divorce in Snohomish County? *
Are you getting ready to finalize a  Divorce in Snohomish County? *
Has there been Domestic Violence between you and the Opposing Party? *
How have you been affected by COVID-19? (check all that apply) *
Required
Will you be willing and able to meet with an attorney with videoconference (Zoom or GoogleMeet)? *
Who referred you to our services?  How did you hear about us? *
Gender *
Birthdate *
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DD
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Age *
Do you reside in Snohomish County? *
Street Address (where you actually live) *
City, State *
Zip Code *
Living Situation? *
Does your legal matter affect the stability of your housing situation? *
Preferred Phone number *
Mobile Phone number *
Can we leave Voicemails at this number? *
Are you willing to receive texts? *
Home Phone number
Email Address *
What is your primary language? *
Do you require or would you like to request an interpreter? *
Client Ethnicity *
Client Race *
Highest Level of Education? *
Health Insurance Status? *
Are you a Veteran? *
Are you disabled? *
Citizenship status? *
Family Type: Family living with you that you are financially responsible for.  (If you are currently living with your spouse and trying to separate, please select 'other' and explain) *
Family Size: How many Adults live with you that are in a personal relationship with you (i.e. domestic partner - do not list roommates) *
Please list the full names of the other adults that are part of your financial household. *
Family Size: How many children do you have that are still financially dependent on you? *
Children's Ages *
How many of your own children live primarily with you? *
What is your GROSS monthly income? (Income before taxes are taken out) (INCLUDE THE INCOME OF ANY DOMESTIC PARTNERS THAT RESIDE WITH YOU) *
What is the source of that income? (CHECK ALL THAT APPLY) *
Required
Please enter the gross amount of EACH source of income, including food assistance. *
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