Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 7CLIENT DETAILSFor which event are you registering for? *June 13 - Maple Valley Public LibraryAugust 15 - Twinsburg Public LibraryOctober 10 - Springfield-Lakemore LibraryDecember 12 - Barberton Public LibraryFuture Ohio Justice Bus - 2026Time Slots (template)11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PMThe event runs from 11:00 a.m. to 3:00 p.m., with time slots available in 30-minute increments. However, time slots may become unavailable due to high demand and will be removed from the options. While you can still walk in, please be prepared for potentially longer wait times. The time slots do not reflect the actual duration of your meeting with the attorney, so we recommend keeping your schedule flexible and free of prior commitments for the day.Time Slots - April *1:00 PM1:30 PMThe event runs from 11:00 a.m. to 3:00 p.m., with time slots available in 30-minute increments. However, time slots may become unavailable due to high demand and will be removed from the options. While you can still walk in, please be prepared for potentially longer wait times. The time slots do not reflect the actual duration of your meeting with the attorney, so we recommend keeping your schedule flexible and free of prior commitments for the day.Time Slots - June *11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PMThe event runs from 11:00 a.m. to 3:00 p.m., with time slots available in 30-minute increments. However, time slots may become unavailable due to high demand and will be removed from the options. While you can still walk in, please be prepared for potentially longer wait times. The time slots do not reflect the actual duration of your meeting with the attorney, so we recommend keeping your schedule flexible and free of prior commitments for the day.Time Slots - August *11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PMThe event runs from 11:00 a.m. to 3:00 p.m., with time slots available in 30-minute increments. However, time slots may become unavailable due to high demand and will be removed from the options. While you can still walk in, please be prepared for potentially longer wait times. The time slots do not reflect the actual duration of your meeting with the attorney, so we recommend keeping your schedule flexible and free of prior commitments for the day.Time Slots - October *11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PMThe event runs from 11:00 a.m. to 3:00 p.m., with time slots available in 30-minute increments. However, time slots may become unavailable due to high demand and will be removed from the options. While you can still walk in, please be prepared for potentially longer wait times. The time slots do not reflect the actual duration of your meeting with the attorney, so we recommend keeping your schedule flexible and free of prior commitments for the day.Time Slots - December *11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PMThe event runs from 11:00 a.m. to 3:00 p.m., with time slots available in 30-minute increments. However, time slots may become unavailable due to high demand and will be removed from the options. While you can still walk in, please be prepared for potentially longer wait times. The time slots do not reflect the actual duration of your meeting with the attorney, so we recommend keeping your schedule flexible and free of prior commitments for the day.Participant Name (Your Name) *FirstLastIntrested Party/Other Party's Name (Person you are seeking action against)FirstLastDate of BirthIntrested Party's Date of BirthDo you have an active case with the Summit County Domestic Relations Court? *Yes, I have an active caseNo, I do not have an active caseNo, I don't have an active case, but I had one.What was the case number?Do you have an attorney?YesNoNo, but I had one.What was the name of the attorney?Contact InformationPhone *EmailMailing Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWhat County do you reside? *SummitAdamsAllenAshlandAshtabulaAthensAuglaizeBelmontBrownButlerCarrollChampaignClarkClermontClintonColumbianaCoshoctonCrawfordCuyahogaDarkeDefianceDelawareErieFairfieldFayetteFranklinFultonGalliaGeaugaGreeneGuernseyHamiltonHancockHardinHarrisonHenryHighlandHockingHolmesHuronJacksonJeffersonKnoxLakeLawrenceLickingLoganLorainLucasMadisonMahoningMarionMedinaMeigsMercerMiamiMonroeMontgomeryMorganMorrowMuskingumNobleOttawaPauldingPerryPickawayPikePortagePreblePutnamRichlandRossSanduskySciotoSenecaShelbyStarkSummitTrumbullTuscarawasUnionVanWertVintonWarrenWashingtonWayneWilliamsWoodWyandotNextDemographic InformationI Identify asMaleFemaleNonbinaryPrefer not to discloseOtherOther (Gender/Identity)RaceBlack/African AmericanAsianHispanicWhiteMulti RacialNative American/Alaskan NativeNative Hawaiian/Pacific IslanderOtherOther (Race)EthnicityHispanicNon-HispanicOtherOther (Ethnicity)LGBTQ+YesNoPrefer not to identifyPrefered LanguageVeteran/Military StatusI served or am serving in the militaryA member of my household served/is active in the militaryRetiredN/AWhich Branch of the military?Discharge status?NextMarital StatusSingleMarriedDomestic PartnerSeparatedDivorcedWidowedHow many people living in your household Ages 0-17Ages 0-17 OnlyHow many people living in your household Ages 18-59Ages 18-59 OnlyHow many people living in your household Ages 60+Ages 60+ OnlyCurrent Housing SituationOwnRentExperiencing HomelessnessStaying with FamilyCheck all that applyRent Amount?Current or Previous OccupationAverage Monthly Household IncomeSource of incomeIs anyone in the household living with a disability? *YesNoDoes anyone in the household receive *Medicaid or MedicareFood StampsSSI or SSDINo one receivesCheck all that applyNextLegal NeedsWhat legal issues are you facing. Please check all that apply.ConsumerCONSUMER (GENERAL)BankruptcyCollectionTaking of PropertySeniorsEmploymentImmigrationEducationFamilyFAMILY (GENERAL)Custody/VisitationDivorceChild SupportDomestic ViolenceOtherUnemploymentDriver's LicenseBenefitsBENEFITS (GENERAL)Social SecuritySSIWelfareMedicareMedicaidTaxesOtherHousingHOUSING (GENERAL)Landlord/TenantPrivateSubsidizedForeclosureOtherExpungement/CQEUnsureWhat other legal issues not defined above are you seeking help with? (In one to two words)Additional DetailsAre you experiencing domestic violence or are you concerned for your saftey (or saftey of your children) *YesNoWould you like us to refer your information over to Victim Assistance Program for support?YesNoBy selecting "yes" you are giving permission to provide this form to Victims Assistance Program.Is another attorney helping you with any problems? *YesNoWhat is the name of the attorney (or Firm)Have you received or been served with any papers about your problems *YesNoWhen did you receive these papers?Is there a court date or hearing date? *YesNoWhat is the approximate Date?Please provide a brief description of your situation *NextAffirmation of your responsesDigital Signature *FirstLastBy typing your name you are affirming that the answers provided are true and complete to the best of your knowledgeI affirm that the answers provided are true and complete to the best of my knowledge. *I affirmNextBrief Advice Clinic Consent to Limited RepresenationWHAT IS THIS CLINIC? This is a free legal clinic sponsored by the Ohio Jutice Bus. You will meet privately with a volunteer attorney to discuss your legal problem. We are not able to provide legal assistance for any criminal law issues or cases (Note: We can help with right to counsel, court costs/fines, or expungement/criminal records sealing questions). HOW WILL IT WORK? The order in which you are called to meet with an attorney will depmd on your legal issue. It will not be based on the time at which you arrived. Here are a few examples of what may happen during your attorney meeting: The attorney may give you the advice or information you need to resolve your problem on your own; The attorney may help you prepare forms that you can file with your local court, without the attorney representing you in the case; The attorney may refer you to a local civil legal service organization or you may be referredd to other community resources. WHAT DOES TIDS ALL MEAN? This is an advice-only clinic. The volunteer attorney will provide you with limited legal service and is under no obligation to help you with your case beyond this clinic session. Their advice will be based on the information you provide to them. You remain responsible for handling your own case after this clinic unless the volunteer attorney or clinic staff specifically tell you otherwise in writing. WHAT AM I REQUIRED TO DO? The intake form that you fill out and return asks for basic information about your situation that helps our attorneys determine your issue, your eligibility for services, and any potential referrals that may assist you. In order for attorneys to be able to help you, they have to check confirm that they or other attorneys with whom they work are not representing someone else on the same case (a conflict). If there was no required pre-registration, the volunteer attorneys will not be able to know if there is a conflict. By meeting with the attorney, you agree to waive any conflicts. Attorneys who volunteer at the clinic are allowed to represent other individuals involved in the case even though they provided advice here. All information shared at the clinic will be held confidential. CONFUSED? Please ask your attorney to clarify or explain any portion of this release! Additionally, if you do not know what your next steps are by the end of your meeting with the attorney, ask them to clarify before you leave. Digital Signature *FirstLastBy typing your name in the above box you acknowledge that you have read the above, and understand and agree with its contents.DateI affirm that I have read the above, and understand and agree with its contents. *I affirmNextHow Did You Hear About Us? *Social MediaCourt House FlyerFriend ReferralReferralInternet/Search EngineTV/RadioThird-Party ReviewOtherIf other, please specifySubmit
