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Legal Services Request
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Name
*
Your answer
Phone Number
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Your answer
Do we have permission to leave a voicemail at the phone number you provided?
*
Choose
Yes
No
Email Address
Your answer
Your Annual Income
*
Your answer
Number of Person in Your Household
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Your answer
Your Household Annual Income
*
Your answer
Amount in Household Savings
*
Your answer
What county do you live in?
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Your answer
What is your zip code?
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Your answer
Do you prefer to communicate in a language other than English?
*
Choose
Yes
No
If yes, what language do you prefer instead of English?
Your answer
In 1-2 sentences, tell us what you need help with.
*
Your answer
How did you hear about our services?
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Your answer
Submitting your information does not create an attorney-client relationship between you and Elevate Community Center. There is no guarantee that Elevate Community Center will provide you with any services, legal or otherwise. We will attempt to contact you three times before moving onto the next person. You can email
info@elevatecommunitycenter.org
or call us at 408-357-9538 with any questions. If you understand and agree, please acknowledge your agreement by typing your name below.
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