Introduction

Legal Services of Eastern Missouri, often called “legal aid”, receives thousands of requests each year from low-income people needing free legal help in many different areas of civil law. (We do not handle criminal cases). As a client, or potential client, we are asking for your help please in determining what the legal needs of your community are, so we can further decide what kind of legal help we should offer and prioritize which kinds of problems are most important to you. Please take a few moments to complete this survey and return it to us as soon as possible. This survey is also available online at www.lsem.org. All answers are confidential. Thank you for your time, your input is extremely valuable to us.

As you go through the survey, Click "next" to go to the next page; click "prev" to go to the previous page; click "done" to submit your survey.

We do not need your name or any information that will identify you but the information below will help us determine what services are needed by persons like you.

Age Group:

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* Age Group:

Zip Code

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* Zip Code

Number of people living in your household:

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* Number of people living in your household:

County where you live:

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* County where you live:

Gender:

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* Gender:

Marital status:

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* Marital status:

Ethnicity/Race:

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* Ethnicity/Race:

What language(s) do you speak at home?

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* What language(s) do you speak at home?

Are you a Veteran?

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* Are you a Veteran?

Are you employed?

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* Are you employed?

Do you have health coverage?

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* Do you have health coverage?

Do you have a serious health problem or disability?

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* Do you have a serious health problem or disability?

If you said "yes", you do have a serious health problem or disability, please check all that apply:

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* If you said "yes", you do have a serious health problem or disability, please check all that apply:

Household income per year:

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* Household income per year:

Does your household qualify for free/reduced lunch, foodstamps, or subsidized housing?

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* Does your household qualify for free/reduced lunch, foodstamps, or subsidized housing?

Where did you receive this survey?

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* Where did you receive this survey?

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