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):


                     $
                     $
                    $
                  $
               $
    $
                  $
                    $


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


Please select the area(s) of law for which you need assistance:


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