Women and Girls' Rights Project Application for Services

Women and Girls' Rights Project Application for Services

For legal assistance please complete the intake form below to the best of your ability and someone from our team will contact you. All information provided to us is confidential and privileged; we will only use the information on this form to get in touch with you and to determine your eligibility for our services. If you prefer to leave a voicemail message, please call our intake line at 213-385-2977 x410.
Date

MonthDayYear
Date
Name*

First NameMiddle InitialLast Name
Do you live in Los Angeles County?*

YesNo
We are only able to provide services to individuals who live in the County of Los Angeles. If you have answered "no" to this question, we may not reply to you because of the high volume of applications that we receive.
What is your zip code? *
Do you identify as female?*

YesNoNonbinary
Our project focuses on advancing economic and gender justice for low-income women and girls (cisgender and transgender). If you do not identify as female but are experiencing discrimination or harassment at work or school based on your gender identity, gender expression, or sexual orientation, please continue this form and we will do our best to assist you or to provide a referral. For other types of employment issues, such as wage theft or unemployment benefits, please contact our partners at Bet Tzedek or Legal Aid at Work.
Do you have a legal issue relating to:

Workplace DiscriminationWorkplace Sexual Harassment/AssaultPregnancy/Breastfeeding (Workplace Accommodations)Sick or Family LeaveCOVID-19 QuestionsUnfair Scheduling PracticesFair PayOther Employment-related Issue (NOT Worker's Comp or Unemployment)Discrimination/Harassment in EducationCampus Sexual AssaultRights of Pregnant/Parenting StudentsCriminal Law/Domestic Violence (Defendants)Domestic Violence/Sexual Assault/Trafficking/Stalking (Survivors)Restraining OrderDivorce/Child CustodyNonprofit/Small BusinessHousing IssuesWorker's Compensation/Unemployment BenefitsOther
Please provide the name of your employer(s).
Please provide the name of your school
We do not assist with family law matters. For assistance, please reach out to:

Harriett Buhai Center for Family Law (for complex divorce and custody matters)
Los Angeles Center for Law and Justice (for survivors of SV and DV seeking family law assistance)
Levitt & Quinn (For divorce and custody matters as well as spousal support and DV restraining orders)
Legal Aid Foundation of Los Angeles (family law assistance for DV survivors)
Domestic Violence / Family - NLSLA (family law services for low-income residents of LA County including child custody, divorce, restraining orders)
WGR is not a domestic violence service provider. f you are a victim of DV, sexual violence, stalking, or trafficking, WGR can advise you of your rights as a victim of crime and protections available to survivors at school and work. If you're in need of that advice, please select "Other employment-related issue (Not Worker's Comp)" to continue filling out this form.

For other assistance relating to domestic violence support, please see below:

For immediate help and information:

24-hour emergency/crisis hotlines:
Peace Over Violence (English and Spanish)
Central Los Angeles: 213-626-3393
South Los Angeles: 310-392-8381
West San Gabriel Valley: 626-793-3385

Center for Pacific Asian Family: 1-800-339-3940 (multi-lingual crisis line/emergency shelter)

East Los Angeles Women’s Center (English and Spanish): 1-800-585-6231 (crisis hotline/emergency shelter)

Jenesse Center: 1-800-479-7328 Hotline

Homelessness or Housing issues: If you are a survivor of domestic violence who is experiencing homelessness or housing issues, please call 1-888-999-7511.

For trafficking survivors: Coalition to Abolish Slavery and Trafficking (CAST)

Legal Services:
Services Request – Los Angeles Center for Law and Justice family law and immigration related legal services for survivors of domestic violence and sexual assault, including restraining orders

Legal Services — Peace Over Violence - family law and immigration related legal services for survivors of domestic violence or sexual assault, including restraining orders

Domestic Violence / Family Law - LAFLA: Legal Aid Foundation of Los Angeles - Court based DV self-help clinics and full range of legal services for survivors of DV, including family law and restraining orders

Asian Americans Advancing Justice
Helplines are open, live hours between 10am and 3pm. Limited staffing for representation.

Phone:
Chinese (Mandarin and Cantonese): 800.520.2356
Korean: 800.867.3640
Thai: 800.914.9583
Tagalog: 855.300.2552
English: 888.349.9695 (warmline, leave a message and an advocate will call back within 24 hours)

Domestic Violence Programs - YWCA Glendale & Pasadena - full range of legal services for DV survivors including legal services (restraining orders, family law and immigration)

Intervention – Jenesse Center - full range of support services for DV survivors and their families, including legal services

Apply for Help - NLSLA – legal services relating to DV, housing, immigration, benefits, etc.

Legal Services - Los Angeles LGBT Center : (323)993-7649.
We do not represent defendants in criminal matters or domestic violence.

Please continue to seek legal counsel with other firms or organizations.
For assistance with your nonprofit or small business, please reach out to the Community Development Project
For assistance with Housing and Landlord/Tenant Disputes or Evictions, please contact:

Housing Rights Center

Housing Rights Hotline: 1-800-477-5977 TTY: 1-213-201-0867

Tenant Services - NLSLA

Housing & Homelessness - LAFLA: Legal Aid Foundation of Los Angeles

Inner City Law Center

Housing First DV: If you are a survivor of domestic violence who is experiencing homelessness or housing issues, please call 1-888-999-7511.

Downtown Women’s Center Housing Assistance for DV survivors and their children: 213-223-2905
We do not represent individuals with Worker's Compensation claims.

For assistance with Unemployment:

NLSLA - Unemployment and public benefits, Covid health & safety.

Legal Aid At Work - Unemployment, this organization can provide services in English, Spanish, Cantonese, and Mandarin and can arrange services in additional languages.

You can also refer to their fact sheet for some general information about unemployment during COVID-19.

For Assitance with Unemployment or Pandemic Unemployment Assistance (PUA) Benefits, please contact Bet Tzedek.
Please Include your Household Size and Household Income (Household means the people you share your home and expenses with) *

Household Size Household Monthly Income
Is anyone in your household receiving SSI, Calworks, GR, CalFresh, or Medi-Cal?Select all that apply.

SSICalWorksGRCalFreshMedi-Cal
Briefly explain your legal issue:
Do you have any upcoming hearings or filing deadlines related to this matter in the next 30 days?*

YesNo
Please continue to seek other legal representation or self-help support while you wait to hear from Public Counsel, as we cannot guarantee that we will be able to take your case.
Age*

Under 1818-60Over 60
Race*

Native AmericanAsian/Pacific IslanderBlackLatinoWhiteMixed RacePrefer not to answer
Preferred Language

EnglishSpanishOther
Do you require interpretation for a telephone intake?

YesNo
Phone*
What are the best days/times to reach you on the phone?
Can we leave you a voicemail?

YesNo
E-mail Address
example@example.com
How did you hear about the Women and Girls' Rights Project?
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please choose from below

I am filling this form out on behalf of myselfI am filling this form out on behalf of someone elseI am employee of public counsel filling this form out on behalf of someone elseOther
If your matter is urgent, please continue to look for other representation, as we cannot guarantee that we will be able to accept your case.

Transmission and receipt of an intake form for legal services does not create any attorney-client relationship between Public Counsel and any person or entity. Public Counsel cannot guarantee the length of time it may take to assess an intake for legal services, but generally, you should expect to hear back from us within three days of submitting the form.
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