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. Do you have any court dates coming up?

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* 3. How many people live in your household?

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

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* 5. Who is the other side? Note: Even if you are in agreement, the other parent in a Parenting Plan/ Parenting Plan modification or other person in a divorce should be listed here. (put N/A if unknown)

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* 6. Is there a Protection Order or No-Contact Order?

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* 7. Demographic Information:

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* 8. What is your current living situation?

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

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

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* 11. What is your occupation?

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* 12. Who is your current or most recent employer?

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

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* 14. In what area of law are you seeking help? (Select the one that best describes your current issue)

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