LSE Application for Attorney Matching (English)

LSE Pro-Bono/Free Attorney Application

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Personal Information

Please enter the date as: mm/dd/yyyy.
Include apartment number, if any.
Name, phone number, and relationship to you of another contact person, in case we can't get ahold of you

Demographic Information

Your answers to these questions are collected for grant reporting purposes. 
Press and hold CTRL to select multiple (or Command on a Mac).
If yes, please check the box.
If yes, please check the box.
If yes, please check the box.
If yes, please check the box.

Personal Financial Information

Your application will not be considered without the following financial information. Your answers are collected to assess eligibility for our program and for grant reporting. 
Number of people who live with and share financial resources with you.
Includes income of spouse, parent or partner in same household. Please enter a number without a dollar sign.
Includes income of spouse, parent or partner in same household. 
Please enter a number without a dollar sign.
Please enter a number without a dollar sign.

Business Information

Include suite number, if any.
Name, phone number, e-mail address

Business Financial Information

Your application will not be considered without the following financial information.
Please enter a number without a dollar sign.
Please enter a number without a dollar sign.
Please enter a number without a dollar sign.
Please enter a number without a dollar sign.
Please enter a number without a dollar sign.
Please enter a number without a dollar sign.
Please enter a number without a dollar sign.

Legal Assistance

Commercial Lease Questions

If yes, please check the box.
If yes, please check the box.
If yes, please check the box.
If yes, please check the box.
If yes, please check the box.
If yes, please check the box.
If yes, please check the box.

Consent for Disclosure of Case Information

By signing below, you understand that all information you provide LSE on this intake form and otherwise, including information developed from it by the Lawyers' Committee for Civil Rights ("LCCR"), is on a non-confidential basis. While LSE/LCCR intends to use and disclose your information only to the extent appropriate, you understand that we will disclose your information to persons unrelated to LSE/LCCR on a non-confidential basis, including to, among others, law firms and attorneys that act as volunteers for LSE/LCCR. Additionally, you agree that any law firm that agrees to represent you as a result of our referral has your consent to provide to LSE/LCCR information about you, your legal matters handled by the law firm, and its representation of you. Please note that LSE/LCCR usually only requests this information from participating law firms for the purpose of improving our program and meeting various ongoing funding requirements.

File Upload

Your application will not be considered without uploaded copies of the requested financial information.
Upload copy of the commercial lease, if applicable.