Snohomish County Legal Services Client Intake
Please submit this intake within 7 days to determine eligibility. After we receive your completed intake and upon eligibility, we will contact you to schedule an appointment. If we don't hear from you within 7 days, we will assume you are no longer interested in our services. PLEASE NOTE - Our staff and volunteer attorneys provide (pro se) advice and counsel; our services do NOT include court representation. Completing this intake does NOT establish an attorney-client relationship and does not guarantee services. ALL ANSWERS ARE STRICTLY CONFIDENTIAL.
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电子邮件地址 *
Last Name *
First and Middle Name *
Are you getting ready to file for Divorce in Snohomish County? *
Are you getting ready to finalize a  Divorce in Snohomish County? *
Has there been Domestic Violence between you and the Opposing Party? *
At this time, do you feel safe in your primary place of residence? Are you afraid or feel in danger from your partner/spouse/significant other/roommate/family member who live with you?
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How have you been affected by COVID-19? (check all that apply) *
必填
Will you be willing and able to meet with an attorney with videoconference (Zoom or GoogleMeet)? *
How did you hear about us? Who referred you to our services?   *
Birthdate *
年
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月
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日
Age *
Do you reside in Snohomish County? *
Street Address (where you actually live) *
City, State *
Zip Code *
Living Situation? *
Does your legal matter affect the stability of your housing situation? *
Preferred Phone number *
Home Phone number
Mobile Phone number *
Can we leave Voicemails at this number? *
Are you willing to receive texts? *
Email Address *
What is your primary language? *
Do you require or would you like to request an interpreter? *
Client Ethnicity *
Client Race *
Gender *
Highest Level of Education? *
Health Insurance Status? *
Are you a Veteran? *
Do you identify as someone living with a disability? *
Citizenship status? *
Family Type: Family living with you that you are financially responsible for.  (If you are currently living with your spouse and trying to separate, please select 'other' and explain) *
Family Size: How many Adults live with you that are in a personal relationship with you (i.e. domestic partner - do not list roommates) *
Please list the full name and date of birth of the other adults who are part of your financial household, along with their date of birth and your relationship with them. (ex. Jane Doe, 01/01/2001, sibling).
*
Family Size: How many children do you have that are still financially dependent on you? *
Children's Ages *
How many of your own children live primarily with you? *
What is your GROSS monthly income? (Income before taxes are taken out) (INCLUDE THE INCOME OF ANY DOMESTIC PARTNERS THAT RESIDE WITH YOU) *
What is the source of that income? (CHECK ALL THAT APPLY) *
必填
Please enter the gross amount of EACH source of income, including food assistance. *
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