FAMILY VIOLENCE PREVENTION SERVICES, INC.

LEGAL SERVICES APPLICATION

PLEASE PRINT

Client’s Name: __________________________________________

Client’s Address: _________________________________________

_______________________________________________________

Client’s Phone #: _________________________________________

Client’s Other Phone #: ____________________________________

(PLEASE NOTE THAT WE WILL TRY TO CONTACT YOU USING THE ABOVE INFORMATION. IF THIS IS NOT SAFE, LET US KNOW IMMEDIATELY)

Please estimate your monthly household income: ____________________

Please list your children below and their ages – indicate whether they live with you and if they are the opposing party’s biological children:

1. __________________________________________________________

2. __________________________________________________________

3. __________________________________________________________

4. __________________________________________________________

5. __________________________________________________________

Are you represented by an Attorney on this matter?  No  Yes

Attorney’s Name ___________________________

(PLEASE NOTE THAT IF YOU ARE CURRENTLY REPRESENTED BY AN ATTORNEY, WE ARE PROHIBITED FROM DISCUSSING YOUR LEGAL CASE WITH YOU)

Is the opposing Party represented by an Attorney on this matter?  No  Yes

Attorney’s Name ___________________________

Do you have any upcoming court settings?  No  Yes

If yes, please indicate the date and identify the court __________________________

Please list all agencies that are or have been involved in your case:

(YOU MAY BE ASKED TO PROVIDE DOCUMENTS RECEIVED FROM ANY AGENCY CHECKED BELOW)

 Family Violence Prevention Services, Inc.

 Child Protective Services

 Drug Court

 Military Family Advocacy

 San Antonio Police Department

 Bexar County Sheriff’s Department

 Bexar County Domestic Relation’s Office

 Office of the Attorney General

 Bexar County District Attorney’s Office

 Family Justice Center

 Other ________________________________________

Please indicate your legal matter:

 Divorce w/ out Children

 Divorce w/ Children

 Protective Order

 Child Custody / Support

 Will / Estate Planning

 Power of Attorney

 Landlord – tenant issues (non-litigation only)

Do you have any prior court orders or legal paperwork on the above?  Yes  No

(PLEASE BE PREPARED TO PROVIDE ANY LEGAL DOCUMENTATION YOU MAY HAVE INVOLVING YOUR LEGAL MATTER)

Please indicate if any of the following apply to you or your children:

 Crime Victim

a. This is verified through police reports, medical records, a protective order, supporting witnesses or some other substantial proof.

b. The legal service sought must be connected with the crime committed against the applicant or child of the applicant.

 Military Personnel, Veteran (within last 10 years) or Military Dependent

a. This is verified through police reports, medical records, a protective order, supporting witnesses or some other substantial proof.

b. The legal service sought must be connected with the crime committed against the applicant or child of the applicant.

ONCE YOU HAVE COMPLETED THE APPLICATION, PLEASE SEND IT TO US USING ONE OF THE METHODS BELOW:

FAX TO: 210.805.0222

MAIL TO: 7911 Broadway, San Antonio, TX 78209

EMAIL TO: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

For Legal Dept. Use Only:

Date of Application: ________________

Name of person involved in intake / client interview: _________________________

Date of Review: ________________

______ APPROVED