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

This form is to be used by participants who have not contacted CLEAR. IELA staff will contact you if you qualify for services. If you already contacted CLEAR and they indicated they referred you to us, please wait for us to contact you.

Please go to our website to see upcoming clinics that are walk-in, with no application required. These would be the fastest way to receive assistance from us.

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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 number amount, do not worry about extra characters)

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* 5. Who is the other side? Notes: 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. In an Consumer Matter, this will likely be the name of your collections agency or landlord. (put N/A if unknown)
DO NOT PUT YOUR NAME DOWN AGAIN.

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

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

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* 10. Do you have a disability?

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* 11. Are you a veteran?

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* 12. What is your current living situation?

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* 13. What is your occupation?

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

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* 15. How did you hear about Inland Empire Legal Aid (formerly Volunteer Lawyers Program)?

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* 16. Explain your legal situation

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

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