Legal Clinic Intake Form (Page 2 of 2) in pdf

SERVICE PERIOD:

 OIF/OEF/OND (9/11/2001 – current)

 Gulf War (8/2/1990 – 3/31/1991)

 Vietnam (2/28/1961 – 5/7/1975)

 Korea (6/25/1950 – 1/31/1955)

 WWII (12/7/1941 – 12/31/1946)

 Other (All Other Dates) _____________

LEGAL ISSUE:

 BANKRUPTCY  BENEFITS  CRIMINAL  CRIM. EXP.  DEBT COLLECTIONS  DRIVERS LICENSE

 EMPLOYMENT  FAMILY  HOUSING  PERSONAL INJURY  TAX  WILL OTHER

(EXPLAIN)___________________________________________________________________

____________________________________________________________________________

COUNTY/STATE OF LEGAL ISSUE_______________________________________



HAVE YOU CONSULTED AN ATTORNEY ABOUT THIS MATTER?

YES

____________________________________________________________________________



DO YOU HAVE ANY OTHER LEGAL MATTERS AT THIS TIME?

YES

___________________________________________________________________________

(EXPLAIN)

___________________________________________________________________________________

DO YOU HAVE AN IMMEDIATE FAMILY MEMBER IN THE US WHO MAY BE IN NEED OF A



GREEN CARD?

YES

Client Acknowledgement

The Minnesota Assistance Council for Veterans Veteran’s Legal Clinic offers you a short meeting with an attorney, free of charge, to

discuss a legal matter. The volunteer attorney can provide information on most legal matters along with brief advice about the next steps you

may wish to take.

I understand and agree to the following: The attorney I meet with today will give me brief legal advice. The attorney will not give me

ongoing legal service after today’s clinic. If I wish to consult with the attorney after today’s clinic a separate representation agreement is

necessary. I remain responsible for all parts of my case. The party on the other side may now or in the future be represented by this attorney’s

law firm. What I tell the attorney today is confidential, although my information can be shared with others in a good faith effort to assist me

in this matter.

______________________________________________________________

_____________________________________________

SIGNATURE OF VETERAN

DATE

Legal Clinic Intake Form Page 2