Completing this form does not guarantee acceptance into the VLP program. 

This form is to be used by participants who have not contacted CLEAR. VLP staff will contact you if you qualify for services.

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* 1. Contact Information

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* 2. How many people live in your household?

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* 3. What is your occupation?

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* 4. What is your total monthly income? (Enter dollar amount)

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* 5. Has your household's income been impacted by COVID?

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* 6. Who is the other side? Note: In an Eviction Matter, this will likely be the name of your landlord or the property management company. (put N/A if unknown)

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* 7. How would you describe your gender?

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* 8. How would you describe yourself?

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* 9. Do you identify as Hispanic or Latinx?

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* 10. If the previous questions does not allow you to accurately identify your race or ethnicity, please describe here how you would identify yourself.

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* 11. Additional Information:

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* 12. What is your current living situation?

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* 13. If you rent, are you up-to-date on rent?

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* 14. If you are not up-to-date on rent, would you like information about resources to assist you? 

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* 15. How did you hear about the Volunteer Lawyers Program?

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* 16. Are you currently working with the ZoNE program?

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