The Way to Justice Form

Wayout Kids & The Way to Justice Intake Form
How did you hear about The Way to Justice?

The Way to Justice EventCompany or OrganizationNews or Social MediaFriendWebsiteOther
WayOut Kids is partnering with The Way to Justice (TWTJ).

1) This is an information gathering form only, and does not automatically make TWTJ represent you.
2) It will take 4-6 weeks before TWTJ can decide to accept your case.
3) If you have court dates, hearings, or deadlines before you hear from us, you must attend all hearings and meet all deadlines.
4) Tell your interviewer if you have a pending court date or deadline and we will prioritize the review of your case.
5) We do not appear in court, file documents, or help resolve any pending deadlines unless we accept your case.
6) All legal claims have a time limit for filing a case with the courts. While we are reviewing your case, you should continue to seek legal representation elsewhere in order to preserve your right to file your case with a court.
7) We are a small, non-profit, public interest law firm and can only accept a small number of cases.
Name*

First NameLast Name
Address *

Street Address

Street Address Line 2

CityState

Zip Code
SINGLEMARRIEDOther
Date of Birth*

MonthDayYear
Date
Age*
Number of Dependents*
Race/Ethnicity*
Gender*
Home or Cell Phone*

Area CodePhone Number
Work Phone*

Area CodePhone Number
E-mail*
Current Employer*
Position Title*
Join TWTJ's Mailing List?*

YESNO
Estimated monthly gross household income (TOTAL) including all benefits: *
Enter $ amount
Number of persons in household*
Is English your primary language?*

YESNO
If No, then what is your primary language ?
Do you need an interpreter?*

YESNO
Do you identify as disabled?*

YESNO
Have you been incarcerated?*

YESNO
Do you have a family member currently incarcerated?*

YESNO
Do you identify as LGBTQI (lesbian, gay, bisexual, transgender, queer/questioning, intersex)?*

YESNO
Are you a Military veteran?*

YESNO
Do you have Healthcare Coverage?*

YESNO
If No Healthcare Coverage, would you like help signing up?

YESNO
Are you registered to Vote?*

YESNO
If Not registered to Vote, would you like to register

YESNO
Have you ever applied for services at The Way to Justice before?*

YESNO
Have you ever applied for services at The Way to Justice before?*

YESNO
If yes, approximate date of application:
Are you currently experiencing food insecurity?*

YESNO
If No, have you ever?

YESNO
Are you currently a victim of Domestic Violence?*

YESNO
If No, have you ever?

YESNO
Have you been impacted by the War on Drugs?*

YESNO
If Yes, can you briefly explain how so?
What are you asking our organization to assist you with? (Brief description)*
Please list people, companies, other parties involved (landlords, employers, witnesses, etc.; please provide first and last names and describe relationship to your case):*
Other information (if known):
Case Number:
Next Court Date:
What Court?
Name(s) of Previous Attorneys:
Name(s) of Previous Attorneys:
Have you applied for representation by the Public Defender?

YESNO
I hereby authorize The Way to Justice to request and review any and all of my records pertaining to my case. I specifically authorize telephone conversations on my behalf by The Way to Justice. Further, this authorization is a general release for The Way to Justice to release any information it deems necessary, and to obtain any information it deems necessary from any party it deems necessary during this application process.
Today's Date*

MonthDayYear
Date
Signature*

Clear
1) This is only an information gathering form. I understand that The Way to Justice does not represent me at this time and I acknowledge that I am only applying for their services.

2) The Way to Justice does not represent you unless and until you are formally notified (typically by letter or email) that The Way has agreed to represent you.

3) I further understand that if I have any pending court dates or deadlines, I must attend those hearings and meet all deadlines. I understand that The Way to Justice will not represent me or file any court or case-related documents for me unless my case is accepted.
Check to accept

I accept
Should be Empty:

Wayout Kids & The Way to Justice Intake Form