This legal template includes 9 fields. Low-income individuals screen for eligibility for free legal aid services. Free to customize and use on ZenBuild.
Full Name (text, required)
Email Address (email, optional)
Phone Number (text, required)
City and State (text, required)
Legal Issue Type (dropdown selection, required) — options: Housing, Family Law, Immigration, Consumer Debt, Benefits, Employment, Criminal Record Expungement
Household Size (dropdown selection, required) — options: 1, 2, 3, 4, 5, 6 or More
Annual Household Income (dropdown selection, required) — options: Under $15000, $15001-$25000, $25001-$35000, $35001-$50000, Over $50000
Are you currently facing an imminent court date? (multiple choice, required) — options: Yes, No
Brief description of your legal issue (long text, required)
