Legal Aid Services Eligibility Screening Form

Legal Aid Services Eligibility Screening Form — Form Fields

This legal template includes 10 fields. Determine financial and case eligibility for free legal aid services. Free to customize and use on ZenBuild.

• Full Name (text, required)
• Email Address (email, required)
• Phone Number (text, required)
• City and State (text, required)
• Household Size (dropdown selection, required) — options: 1, 2, 3, 4, 5, 6, 7+
• Annual Household Income (dropdown selection, required) — options: Under $15, 000, $15, 000–$25, 000, $25, 000–$35, 000, $35, 000–$50, 000, Over $50, 000
• Legal Issue Type (dropdown selection, required) — options: Housing/Eviction, Family Law, Immigration, Consumer Debt, Employment, Public Benefits, Criminal Record, Other
• Brief Description of Legal Issue (long text, required)
• Are you currently facing a court deadline? (multiple choice, required) — options: Yes – urgent, No
• Have you previously received legal aid? (multiple choice, required) — options: Yes, No