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  • PLEASE READ BEFORE YOU CONTINUE:

    Security of your sensitive information provided in this form is important to us. Therefore, we cannot SAVE your entry to complete at a later time. 

    Please have ALL your information ready to input/upload and allow time to complete this form. (Full Name(s), Documents, Dates, etc.)

  • APPLICATION FOR LEGAL SERVICES

    DIVORCE

     

  • PLEASE ANSWER ALL REQUIRED QUESTIONS IN THIS APPLICATION. THE FOLLOWING INFORMATION IS FOR OUR USE ONLY. WE WILL LET YOU KNOW IF YOUR APPLICATION HAS BEEN ACCEPTED WITHIN FOUR WEEKS.

  • Do you have a pending case in court?
  • When was the case filed?
     - -
  • Was the case filed by you or your spouse (opponent)
  • If the case was filed by your spouse ( or opponent), when were you served?
     - -
  • If the case was filed by your spouse and you were served, did you file an answer?
  • If the case was filed by you, did you have an attorney?
  • What date is your next court hearing?
     - -
  • Are you receiving services from Family Violence Prevention Services?
  • Do you have a copy of your pleadings and court orders?
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  • Which copies of EVIDENCE do you have? (Check all that apply)
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  • YOUR INFORMATION

  • Do you want your maiden name restored?
  • Is it safe to receive mail at the above address
  • Does your spouse know where you are residing?
  • Do you want your address kept confidential?

  • Please provide your contact information below where our agency can reach you.

  •  -
  • Is this Home Phone Number safe?
  •  -
  • Is this Work Phone Number safe?
  •  -
  • Is this Cell Phone Number safe?
  • Is this Email Address safe?
  •  -

  • YOUR INFORMATION

    CONTINUED

  • Below, please provide some information about yourself. If you do not have a Social Security Number or Driver’s License, please write “N/A” in the appropriate space(s).

  • Date of Birth
     - -
  • Are you a U.S. Citizen?
  • Do you have a VISA, Work Pass or Other?

  • Are you a Permanent Resident?
  • Are you Undocumented?
  • Are you currently in the military?
  • Active Duty or Reserves?
  • Are you retired or separated from the military?
  • Were you honorably discharged?
  • Are you employed?

  • FAMILY VIOLENCE

  • Do you have a Protective Order?
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  • Do you feel you need a Protective Order?
  • Have you ever filed charges against your spouse?
  • Are you aware of any scheduled court dates?
  • Have you been to court for any reason?

  • Incident Information

  • To assist our agency in assessing the urgency of your case, please state the nature of the violence that happened to you and/or your children. Give the month, day, and year of each incident and explain what the adverse party did. Please note if there are police reports and, if so, give the case numbers. Please include ALL the incidents of violence you experienced, including those that are not very recent and those that did not involve the police. If you do not remember the dates of incidents of violence, please write “N/A” in the appropriate space(s). If the violence you experienced occurred over a long period of time or constantly during your relationship and you cannot recall a specific incident, please record the long term mistreatment and explain the frequency with which it happened.

  • Incident #1

  • Were the police contacted?
  • Would you like to report a 2nd Incident?

  • Incident #2

  • Were the police contacted?
  • Would you like to report a 3rd Incident?

  • Incident #3

  • Were the police contacted?

  • SPOUSE INFORMATION

  • Can your spouse be served at the above address?
  • Date of Birth
     - -
  •  -
  •  -
  • Is your spouse currently in the military?
  • Active Duty or Reserves?
  • Is spouse retired or separated from the military?
  • Was he/she honorably discharged?

  • Other sources of income for your spouse:

  • Is your spouse a U.S. Citizen?
  • Does your spouse have a mental or physical condition?
  • Has your spouse ever been arrested?
  • Have details of a 2nd known arrest?
  • Have details of a 3rd known arrest?
  • Have details of a 4th known arrest?
  • Have details of a 5th known arrest?

  • MARRIAGE INFORMATION

  • Date of the marriage
     - -
  • Are you formally married? (married by a court or church)
  • If you are not formally married, do you have a common law marriage?
  • Are you and your spouse still living together?
  • What is the Date of Separation?
     - -
  • Has he/she visited the child/ren?

  • MARRIAGE INFORMATION

    Continued

  • INFORMATION ABOUT CHILDREN

  • List all of your minor children, even if they have different parents and even if they are not currently living with you:

  • Add Child #2?
  • Add Child #3?
  • Add Child #4?
  • Add Child #5?
  • Add Child #6?
  • Add Child #7?
  • Do the children have medical insurance?
  • Do you want custody of the minor children you have with the your spouse?
  • Does the your spouse want custody of your minor children?
  • Are you pregnant?
  • What Is your due date?
     - -
  • Does your spouse know you are pregnant?
  • Do all of the children you are seeking custody of have their father’s last name on their birth certificate?

  • Name of any children with mental/physical disabilities:

  • Do any of your children own property (such as savings account, car, land, or anything of value)?
  • Has anyone from CHILD PROTECTIVE SERVICES ever contacted you?
  • Have you contacted the Attorney General’s office for child support?
  • Have you or your spouse been to court for child support?
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  • PROPERTY INFORMATION

    If you or your spouse own any of the following property, please check all that applies:
  • Home

  • Car

  • Retirement Account

  • Savings Account

  • Certificate of Deposit (CD)

  • Thrift Savings Plan

  • Rental Property

  • YOUR FINANCIAL INFORMATION

    The following information will be used to determine financial eligibility and to prepare an affidavit. If we are able to accept your case, you will be required to sign and notarize the affidavit, so that you will not have to pay filing fees. This information MUST be accurate.

  • MONTHLY INCOME

  • If you were referred to our agency, how did you find out about our services?

  • By signing and submitting this form you certify that the information provided herein (this web form) is true and correct to the best of your knowledge.

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