Legal Aid Client Intake Form
Personal Information
Full Name
Date of Birth
Address
City
State
ZIP Code
Phone Number
Email Address
Demographic Information
Gender
Race/Ethnicity
Primary Language
Citizenship Status
Income & Employment
Employment Status
Monthly Household Income
Household Size
Legal Issue
Type of Legal Issue
Brief Description
Opposing Party (if any)
Upcoming Court Date
Additional Information
How did you hear about us?
Additional Notes