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

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