Protective Parents
Required fields are marked with an asterisk*
Date Litigation began
-
Month
-
Day
Year
Date
Case Number
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
Email
example@example.com
Opposing Party Name(s)
Was Domestic Violence an element of the relationship/litigation?
*
Yes
No
Were there allegations of abuse?
*
Yes
No
Did allegations of abuse adversely impact custody for the party making the allegation?
*
Yes
No
Judge(s) If any of these do not apply, please put N/A
*
Custody
Child Support
Child Support
Equitable Distribution
Additional Judge(s)
Custody
Child Support
Child Support
Equitable Distribution
Have you ever filed a complaint with your state's Judicial Review Committee?
*
Yes
No
If you filed a Judicial Complaint, was there a resolution?
*
Yes
No
Phone Number
Please enter a valid phone number.
Brief synopsis of your case
Please describe the main issues or problems you are experiencing
How long have you been experiencing these issues?
Was Mental Health ever mentioned in your case even in passing?
*
Yes
No
Were you or the opposing party ever evaluated for mental health issues?
Yes
No
Both
I was, the opposing party was not
The opposing party was, I was not
Was Substance Abuse an Issue for either party?
Yes
No
Who had the substance abuse issue?
You
Opposing Party
You and Opposing Party
If yes, please provide brief details of any substance abuse issues
Mental Health History (if applicable)
Have you ever been denied an opportunity to present evidence?
*
Yes
No
Marital Status
Single
Married
Divorced
Widowed
Separated
Children
Yes
No
If you have children, are any of your children special needs?
If yes, please list their ages and any relevant information
Living Situation
Alone
With Family
With Friends
Other
Do you have any other children who are not the subject of the current litigation?
*
Yes
No
If you have other children who are not the subject of your current litigation, what is your custody arrangement for those children? Type 'N/A' if not applicable
*
Current Employment Status
Employed Full-Time
Employed Part-Time
Unemployed
Student
Retired
Other
Occupation
Highest Level of Education
High School
Associate's Degree
Bachelor's Degree
Master's Degree
Doctorate
Other
Source of Income
Employment
Social Security
Disability
Unemployment
Other
What outcomes are you hoping to achieve?
*
Is there anything else you would like us to know?
Date
-
Month
-
Day
Year
Date
Submit
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