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Intake
Please fill out the below online intake system for the Access to Justice Hub and DCLC.
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Step
1
of 2
Legal Full Name
*
Support Person Full Name (if completing this form on behalf of someone)
Name commonly known as (if not legal name)
Date of Birth
*
Email
Street Address
*
City
*
Province
*
Postal Code
*
Phone Number
*
Other Party Name (REQUIRED for Tenant and Family Law Requests)
Other Party Address (if known)?
Monthly Household Income
*
LEGAL SERVICES SUPPORT REQUEST – Select your 1 to 3 Primary concerns
*
Employment & Work
Housing (Tenant Rights & Evictions)
Human Rights
Social Assistance (OW, ODSP, CPP-D)
Seniors’ Issues
Sexual Harassment in the Workplace
Intimate Partner Violence (if this is an emergency call 911)
Wills & Estates (simple)
Powers of Attorney
Immigration (legal information)
Small Claims
Provincial Offences
Other
(Please note we do not practice Family or Criminal Law)
Have you called us before?
*
Please select
Yes
No
Unsure
When?
Do you have an existing lawyer or paralegal professional you are currently working with?
*
Please select
Yes
No
Unsure
Other
Have you been ‘served’ any papers, ‘given notice’, or received an ‘order’ from a court or tribunal?
*
Please select
Yes
No
Unsure
Are you aware of any upcoming deadlines?
*
Please select
Yes
No
Unsure
Have you already attended any hearings or court dates?
*
Please select
Yes
No
Unsure
Are you in receipt of any financial assistance / benefits?
*
Please select
Yes
No
Unsure
Have your benefits / financial assistance stopped?
*
Please select
Yes
No
Unsure
Do you have any existing agreements or contracts in place with the ‘other party’?
*
Please select
Yes
No
Unsure
YOUR STORY (please include dates)
(Please tell us a bit about your issue)
Next
OTHER DEMOGRAPHICS
We collect information about the people who contact us to help us better understand our clients and community. This will help us to develop and give services that reflect the needs of our community. If you would like to tell us about your race, language, gender, and how you like to be addressed (pronouns), we appreciate your input. Giving us this information is voluntary. You can choose "Prefer Not to Answer".
Your ethno-racial group?
Please select
Inuit
First Nations Non-Status
First Nations Status
Registered Metis
Non-Registered Metis
Indigenous (outside North America)
White/Caucasian (North America)
White/Caucasian (outside North America)
Latin American
Asian – South Asia
Asian – South West Asia
Asian – Filipino
Asian – Chinese
Asian – Japanese
Middle Eastern – Arab
Middle Eastern – Other
African Ancestry – North America
African Ancestry – Caribbean
African Ancestry – European
African Ancestry – North Africa
African Ancestry – South Africa
African Ancestry – East Africa
African Ancestry – West Africa
African Ancestry – Somalia
Other/Mixed (please specify)
Other
Your gender identity?
Your preferred pronouns?
Your first language?
Do you require an interpreter?
Please select
Yes
No
Marital status?
Number of family dependants?
Do you require any accommodation?
Please select
Yes
No
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