Charleston Legal Access Intake Request

¿Necesita ayuda legal en español? Llame a nuestra línea de admisión al 843-640-5980, ext. 2, para hablar con nuestro personal bilingüe. _______________________________________________ Information submitted to Charleston Legal Access is confidential; however, submission of this form does NOT mean that Charleston Legal Access represents you. You DO NOT have an attorney unless and until you have met your attorney in person, signed a retainer agreement, and agreed to the terms of representation. We are a small nonprofit and can only take a limited number of cases.

Name:

Today's Date:

Phone Number:

Email Address:

What is the best way to contact you?

Address:

{name}

County in which you will need to file your case:

Age

Birthdate

Race/Ethnicity

Gender

Do you have a disability?

Are you a Veteran?

Legal Area

Description of legal issue:

{name}

Do you have an upcoming court date?

If so, when?

What are the name(s) of the other party(ies) involved in this matter?

Does the other party have an attorney (please list if so).

{name}

Annual household income:

Please enter the annual gross (before taxes) household income below for each adult in the home.

How many people live in the household (including yourself)?

Please select all of the sources of income that are applicable to you.

What are your assets?

How did you hear about us?

{name}

Supporting Documents

Please include any supporting documents that may help us better assess your matter (for example: court orders, notices, police reports, court filings, etc.)

Attach file

Drop files here

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