Family Law Project Client Intake Form

The Women's Bar Foundation's Family Law Project connects low-income survivors of domestic violence with pro bono legal representation. We advocate for our clients through abuse prevention hearings and family law cases.

The following questions will help us determine your eligibility for our services. All answers are completely confidential and will NOT be shared with anyone besides WBF staff and your attorney.

Once you have submitted this form, you can expect to hear from us within a week regarding your eligibility. If we determine that you qualify for our services, we will schedule a phone evaluation.

Thank you for your interest in the Family Law Project.

1 Start 2 Children 3 Financial Info 4 OP Info 5 Court Info 6 Additional Info 7 Review and Submit 8 Complete

Contact Information

First Name *

Last Name *

Is the client currently represented by an attorney? *

If yes, what is the name of the attorney

Gender *

Pronouns *

Please indicate your pronouns if not listed above:

Date of Birth *

Month

Day

Year

Phone Number *

Have you experienced domestic abuse in your relationship? *

Is it safe to leave a voicemail at this phone number? *

Yes

Best time to call:

Please indicate the best time for us to contact you via phone.

Morning

Afternoon

Evening

Safe Residential Mailing Address *

City *

State *

Zipcode *

Race *

Preferred Language *

Are you a U.S. citizen?

NOTE: Eligibility for our services is NOT dependent on any particular immigration status.

Yes

If not a US citizen, please explain your current status.

Have you lived in Massachusetts for at least a year? *

Yes

Court County *

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