Intake Form

The Legal Rights Center ONLY TAKES CRIMINAL CASES charged in Hennepin County. We are unlikely to take representation requests made too close to a trial date for us to adequately prepare. Please complete this form to request an attorney to represent you. Anything you tell to a Legal Rights staff member is private and confidential. The courts cannot force any Legal Rights Center staff member to disclose any information you provide to us. The information you provide here helps us to provide high quality defense services in alignment with our mission. Please and thank you for completing this form.

Today's Date

First Name

Last Name

Phone

Gender

Male
Female
Transgender
Non-binary/Non-conforming
Prefer Not to Respond

Date of Birth

Address (street, city, state, zip)

{name}

Courthouse

Backup contact

If we are having trouble reaching you is there someone else we can contact to help us get in touch? Please include name and contact information.

Race/Ethnicity (select all that apply)

Preferred Language

English / Ingles
Hmong
Other
Somali
Spanish / Espanol

Do you need an interpreter?

Yes/Si
No
English / Ingles

Are you a United States Citizen?

Yes/Si
No

Referred by (select all that apply)

Are you currently employed?

Yes - Full Time
Yes - Part Time
No

Employer

Length of Employment or Unemployment

Household Monthly Income (after taxes)

Number of People Living in Your House

Public Assistance (check all that apply)

Total monthly financial support paid for children not living with you

Please list household members and other children for whom you have financial responsibility .

Include name, relationship, and age

{name}

Please describe any other unusual outstanding debt or financial obligations.

Please describe the legal problems or questions that you are seeking support for.

If you have already spoken to a Community Advocate or other LRC contact person, please also note that person's name here.

{name}

Case Number(s)

If multiple, please separate by a comma (",").

Severity of Charge

Select an option

Pending Criminal Charges and/or Legal Problems or Questions

Please include the charge, severity (misdemeanor, gross misdemeanor, felony), and if it's a probation violation.

{name}

Next Court Date, Time, Location, and Type of Appearance

Do you have other open criminal cases?

Yes/Si
No
Currently on probation
1/30/25

Any other non-criminal legal problems or questions?

Yes
No
Yes/Si

Do you already have another private attorney or public defender working on your case?

Have you been represented by Legal Rights Center before?

Yes/Si
No

Who was your lawyer?

Student

Veteran

Are there any other issues or problems in your life that you would want your attorney to know or for which you are looking for help?

{name}

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