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Benton Franklin Legal Aid Application
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Name
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First
Last
Previous Last Names?
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Phone Number
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Date of Birth?
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Email
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Can we text you?
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Yes
No
Address
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Line 1
Line 2
City
State
Zip Code
Country
SEX
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Male
Female
Have you received help from Legal Aid in the past?
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Yes
No
Ethnicity:
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African American
Native American
Asian-Pacific Islander
Caucasian
Hispanic/Latino
Other
Are you a United States Citizen?
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Yes
No
If no, what is your status?
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Status does not affect eligibiltiy
Number of Adults in Household
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Number of minors in household
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Language spoken
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Income
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Employment
Social Security
Social Security Disability
TANF
Pension
Labor & Industries
Child Support
Unemployment
Other
Please provide proof of income for all members of household. These include the last 2 months of income verification using paystubs, bank statements, tax returns, etc.
Please provide proof of income for all members of household. These include the last 2 months of income verification using paystubs, bank statements, tax returns, etc.
Brief description of your legal issue
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County of dispute
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Franklin
Benton
Have you used an Attorney in the Tri-Cities in the past?
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Yes
No
If so, what is the name of the Attorney?
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Name of person on other side of this case:
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Do they have an Attorney assisting them on this case?
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Yes
No
If yes, what is the name of their Attorney?
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Are there any upcoming court dates?
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Yes
No
If yes, what is the most recent upcoming court date?
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Case Number:
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If case is already filed with the courts, please provide the case number
I understand Benton Franklin Legal Aid staff may consult with and share information with the following agencies/persons regarding my legal case:
Benton Franklin Courts
Benton Franklin Attorneys
Benton Franklin Prosecutors
Correspondents with Mediators
Law Enforcement
Others
The Attorneys who may perform legal services for you are donating their time out of a genuine desire to assist those in need. Their work on your case is done at their discretion and they can terminate the relationship with you at any time for any reason. In the event the attorney chooses to terminate the relationship, you may not be eligible for additional legal aid assistance on that issue. You are responsible for any out-of-pocket expenses not related to the attorney themselves such as filing fees, mediation and copies of documents that may need to be made.
In appreciation for the donation by the attorney of their time and staff resources to you, you should adhere to the following code of conduct:
Arrive on time to your appointment(s).
Bring all relevant paperwork with you to each appointment.
Do not miss any appointments and call in advance if you need to reschedule an appointment.
If the attorney asks you to do something to assist with your case, do it quickly.
Be polite to the attorney and their staff. The attorney does not make the law, they can only advise you of what the law is.
Thank the attorneys for working on your case, the attorneys are very busy and have many other cases. The attorneys have volunteered to donate their time to you.
The Benton-Franklin Legal Aid office assists individuals who are not currently represented by an attorney. The Executive Director and assistants are not attorneys, therefore, cannot give legal advice. You are advised to consult with an attorney.
Our office can answer basic questions about forms and procedures.
The director and assistants cannot:
Give legal advice.
Help with legal strategy.
Speculate on how the case may turn out.
Be held responsible for the accuracy of the information you provide to the court.
I declare under penalty of perjury that Legal Aid will be the first agency that I contact in the event that an issue arises between the assigned pro bono attorney and client. In the event that I miss an appointment with my pro bono attorney and do not call ahead of time to cancel or reschedule, my services with Legal Aid will be terminated. I agree to follow the grievance procedures that Legal Aid has gone over in our intake interview. I also understand that failure to do so can
AND WILL
result in the removal from the program and from receiving any future services (
regardless of the issue) with Legal Aid.
By signing below, I agree to all the terms and conditions stated above.
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