• PARENTS AGAINST RACISM SIMCOE COUNTY (PARSC) LEGAL Support – INTAKE FORM

    PLEASE READ CAREFULLY If you need assistance with this form, call 705-623-9791 to set up a time to complete it with the Legal Coordinator. This form is used to determine whether you may be eligible for the legal services program and to collect basic information about your legal matter. Completing this form does not mean your matter has been accepted and does not create a lawyer-client or paralegal-client relationship. PARSC completes the initial intake and eligibility screening. If you appear eligible, your matter may move to the next stage of the intake process and may ultimately be referred to D.A. Commissioning & Legal Services “D.A. Legal” for review. D.A. Legal makes the final decision about whether a matter is accepted. This initiative is generously funded by The Government of Canada. Once you complete this form, you will get an EMAIL TO BOOK YOUR INTAKE APPOINTMENT with the Legal Coordinator.

  • 1. Personal Information

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Pronouns
  • Format: (000) 000-0000.
  • Preferred Method of Contact*
  • Is it safe for us to leave you a voicemail?*
  • Region*

  • 3. Identity Information

  • Do you identify as Black?*
  • Which of the following best describes your ethnicity? Select all that apply.*
  • Which response best describes your Indigenous identity? Select one response.*
  • Which gender do you identify with? Select one response.*
  • Which of the following best describes your ethnicity? Select all that apply
  • What language would you prefer to receive legal services in? Select one, or explain if more than one language is needed.*

  • 3A. Demographic Information for Grant Reporting

  • The project funder requires PARSC to report the number of clients who access legal advice services, grouped by demographic categories. Identifying information WILL NOT be shared.

  • 4. Financial Information

    **Proof of Income will be required.
  • What is your approximate annual personal income before taxes?*
  • What is your approximate annual household income before taxes?*
  • Current sources of income*

  • 5. Area of Law

  • What type of legal issue are you seeking help with?*

  • 6. Urgency and Deadlines

  • Urgency, Representation, and Prior Legal Contacts

  • Are there any upcoming deadlines, hearings, meetings, mediations, termination dates, eviction dates, or response dates related to your matter?*
  • If yes, date
     - -
    2 digit month, 2 digit day, 4 digit year

  • 7. Other Legal Assistance

  • Please tell us in point form,
  • Do you believe your matter requires urgent attention?*

  • 8. Accessibility and Support Needs

  • Are you currently represented by a lawyer, paralegal, union representative, or another legal service provider regarding this matter?*
  • Have you contacted another legal organization about this matter?
  • PARSC will also use the demographic information collected in this form to prepare the project reporting required by its funder. These reports DO NOT USE client names or personal details that will allow you to be identified. You may leave individual demographic questions unanswered. If my matter proceeds to the referral stage, PARSC will obtain any additional information or consent required before sharing my information with the legal service provider. I can change my mind and remove consent by emailing legal@parsc.ca

  • 9. Consent to Collect and Use Information

  • I understand that PARSC will collect the information in this form to:

    • determine whether I may meet the program’s eligibility requirements;

    • identify the general area of law involved;

    • identify any urgent deadlines;

    • contact me regarding the next stage of the intake process; and

    • determine whether my matter may proceed for further review.

  • 10. Important Legal Disclaimer

  • I understand that:

    • completing this form does not mean my legal matter has been accepted;

    • submitting this form does not create a lawyer-client or paralegal-client relationship; • PARSC conducts an initial eligibility screening;

    • additional information may be required before my matter can be referred;

    • DA Legal makes the final decision about whether a matter will be accepted; and

    • I remain responsible for protecting my legal rights and meeting any legal deadlines unless I receive written confirmation that a legal professional has agreed to assist me.

  • Accommodations, Interpretation, and Consent

  • Do you require any accommodations to participate in the intake or legal service process?*
  • Do you require interpretation or translation support?*
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: