Legal Aid of East Central Indiana client intake form

Client Intake Form

  • STEP 1: Fill out this application to the best of your ability
  • STEP 2: Review information. Agree to retainer/citizenship/release
  • STEP 3: Submit

Legal Aid of East Central Indiana will review your application for program qualification. Please note that qualification with Legal Aid of East Central Indiana does not guarantee placement with a pro bono attorney. If you qualify, the Legal Aid of East Central Indiana office will attempt to refer your case. If a referral is made, the decision to accept you as a client is solely determined by the attorney.

If you have an emergency or court deadline you should make every attempt to obtain private counsel of your own choosing.

*  Indicates a required field



For example January 13, 1995 would be 01/13/1995

In dollars and cents, list the amount of your pre-tax gross income that comes from the following types of income sources for everyone living in your household (These fields are required).

Note: Your application cannot be processed if you enter "0" for all fields in this section:

                     $
                     $
                    $
                  $
               $
    $
                  $
                    $


Please indicate the present value of the following assets (required).


Please select the area(s) of law for which you need assistance (you are required to select at least one area from below):




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