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JAMLAC Legal Aid Client Intake Form
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Work Entry
Added: 1/21/2025
First Name
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Last Name
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Address
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Mobile Phone
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Birthday
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Birthday cannot be a future date.
Gender
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Male
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Marital Status
Married
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Currently, are you a:
U.S. Citizen
Legal Permanent Resident (LPR)
Legal (L)
Visa Holder (not LPR)
Other
Currently, are you a: is required.
Ethnicity:
Asian
Black/African American
Hispanic/Latino
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Native Hawaiian or Pacific Islander
White/Caucasian
Multiracial/Other
Ethnicity: is required.
Do you have any disabilities
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Yes
Do you have any disabilities is required.
Are you fluent in English?
No
Yes
Are you fluent in English? is required.
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