Legal Assistance Intake Form | Volunteers For Youth Justice | Shreveport, LA

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Home
About Us
Programs
Volunteer with VYJ
VYJ Partners
THE HARBOR
EVENTS
Contact

MCC Legal Assistance Intake Form

Eligibility requirements:

187.5% of the federal poverty guidelines

Children living in your home between the ages of 0-17 years

Contact Us

Ethnicity

Caucasian

African America

Native American

Hispanic

Asian/Pacific Islander

Marital Status

Single

Married

Separated

Divorced

Are you a citizen of and eligible alien of the USA?

Yes

No

Gender

Male

Female

First Name:

Last Name:

Phone:

Email:

Free Text

Address

Address (Line 1)

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Name of Adverse Party:

# of People Living in the Household:

Total Household Income:

Source of Income:

Other

List the VYJ program you are currently involved in:

Do you have children between the ages of 0-17 currently living in your home?

Yes

No

Brief Description of Legal Problem:

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900 Jordan, Suite 102

Shreveport, LA 71101

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