Legal Clinic Intake Form

If you require a translator, please call us at 414-344-1220

First Name(Required)

Last Name(Required)

Age(Required)

Gender(Required)

Race(Required)

Phone(Required)

Email Address(Required)

We highly encourage you to provide an email address!

Primary Contact Method(Required)

Telephone

Please note our staff may reach out by phone or email.

Zip Code

County of Residence

State of Residence

Number of people over 18 in your house (including you)(Required)

Child(ren)'s Information

First Name	Last Name	Age	Actions

There are no Entries.

This information allows us to gather a better understanding of your current situation.

Reason(s) the child is in your care:

One or more parent is deceased

One or more parent is incarcerated

One or more parent struggles with alcohol or substance use disorder

Police brought the child to my home

CPS brought the child to my home

Child’s parent(s) brought the child to my home

Child has been in my care for a significant period of time

I cannot contact the child’s parents

Main Questions/Concerns

I cannot enroll the child in school

I cannot take the child to the doctor/dentist

I cannot access public benefits (for example Food Share, Child Care, Health care or other)

CPS told me to get guardianship

Kinship told me to get guardianship

The DA’s office or Victim Witness referred me for assistance

Another agency/professional told me to get guardianship (please specify below)

Additional Notes/Comments

If you were directed by another agency/professional to get guardianship (please specify here)