3 Judicial District Access to Justice Committee - Ask-A ...

[Pages:2]Table Num. ____________________ Order/Time: _________ /__________ Attorney: _____________________

3rd Judicial District Access to Justice Committee - Ask-A-Lawyer Day _______________________REGISTRATION FORM______________________ Personal Information

Name:_____________________________________ Phone:______________

Address:___________________________ D.O.B.:____________ Age:_____ ___________________________

Marital Status: Single Married Divorce Separated Sex: Male Female Race/Ethnicity: Caucasian Hispanic or Latino Native American African American Asian Other____________________________________________

Yearly Household Income: Less than $8,000 $8,000-$13,999 $14,000-$21,999 $22,000-$30,999 $31,000-$41,999 $42,000-$57,999 $58,000-$64,999 Greater than $65,000 Number of Dependents in Household: ________ __________________________________________________________ Type of Case (Choose One) Domestic Relations (Divorce, Custody, Child Support, Parenting Time, Paternity, Parental Rights, Dependence & Neglect) Adoption Conservatorship/Guardianship Adoption Appeals Small Claims (Up to $7,500) Evictions (FED) Garnishment County Civil ($15,000 or less) District Civil (More than $15,000) Probate (Trusts, Estate, Wills) Landlord/Tennant Property Protection Orders Water Other______________________________

Table Num. ____________________ Order/Time: _________ /__________ Attorney: _____________________

Does a conflict exist with any participating Ask-A-Lawyer Day attorneys? Yes No Explain:________________________________________________________ _______________________________________________________________ _______________________________________________________________

How did you hear about the Ask-A-Lawyer Event?: _____________________

Please provide a brief description of your legal issue: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________

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