This request form is designed to assist us in the evaluation of your legal problem. When completing this form, please be as specific and detailed as possible. It is important that all questions be answered fully and completely as certain information is required due to our funding requirements.

Unfortunately, our resources are limited. We take cases that raise significant issues and which have the potential to impact others in the same situation. We cannot take all cases offered us, even those concerning real injustices. If we do not accept your case, it does not mean it is without merit.

If we need further information, we have your address and/or telephone number and can request any documents necessary.

We will be respond to your request within 30 days of receipt. If you do not hear from us within 30 days, please contact us.

SUBMISSION OF THIS REQUEST FORM AND REQUESTS YOU MAY RECEIVE FROM US FOR FURTHER INFORMATION, OR DISCUSSIONS WE MAY HAVE WITH YOU, INCLUDING PROVIDING PRELIMINARY SUGGESTIONS REGARDING THE POSSIBLE RESOLUTION OF YOUR COMPLAINT, DOES NOT CONSTITUTE ACCEPTANCE OF YOUR CASE AND THE FORMATION OF AN ATTORNEY/CLIENT RELATIONSHIP.

Although we keep our files confidential, submitting cases via the Internet is not a secure means of transmission. If you do not wish to submit your form via the Internet, you may download the PDF version of this form, complete the form, print and mail it to the postal address: 1229 NW 12th Ave, Gainesville, FL 32601-4113.

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Address
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Agency Address
Witness #1 Address
Witness #2 Address
Attorney’s Address

10. Household Income. SLC receives grants to represent low income persons. Sometimes we take cases even if you are not considered "low income." Please fill out this information even if you think you do not qualify for "low income."

What is the gross income from a job or self-employment for everyone living in the house for:

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