Pro Bono Legal Services Initial Screening Questionnaire
Full Name
Date of Birth
Residential Address
Phone Number
Email Address
Annual Household Income
Number of People in Household
Employment Status
Employed
Unemployed
Student
Retired
Other
Brief Description of Legal Issue
Name of Opposing Party (if any)
Have you received legal assistance on this matter before?
Yes
No
If yes, please provide details
Are you currently represented by another attorney for this issue?
Yes
No
Other Relevant Information