Family Law Application – Dade Legal Aid

Today's Date(Required)

Referred by:

If you or the other party have filed for or answered any court proceeding in family court please provide:

Miami-Dade County Case #

Your Information

Date of Birth(Required)

Social Security Number

YOU MUST LIVE IN MIAMI-DADE COUNTY TO APPLY FOR OUR SERVICES

How many years have you been living in Miami-Dade County(Required)

Home Phone Number(Required)

Cell Phone Number(Required)

Email(Required)

Demographics

Country of Birth(Required)

Language Spoken

Household

Number of people under 18 in your household(Required)

Number of people 18 and over in your household(Required)

Business Name

Business Phone

Number of Employees

Other Party's Information

Phone Number

Date of Birth
MM slash DD slash YYYY

Social Security Number

Source of Income

Amount per Month

Business Name

Business Phone

Number of Employees

Children with the Other Party

To add additional children, click on the plus icon on the right after selecting "Yes" and enter the child's information.

How can we assist you?

Briefly explain your situation and what you would like Legal Aid to do for you

Acknowledgement

Based upon the information I have provided I may qualify to receive free legal services. If my case is initially accepted and I am referred to a staff attorney for a further intake appointment, the attorney will gather additional information necessary for the final review of eligibility. I agree and understand that until I have met with the attorney and Legal Aid has accepted my case, Legal Aid does not represent me, will not make any appearances on my behalf, and does not take any responsibility for my case. I understand and agree that if I fail to appear for the intake with an attorney, or do not provide necessary documents for my case, my file will be closed with this office, and I must reapply if I decide to proceed in the future.

Signature(Required)

In accordance with the Americans with Disabilities Act of 1990, persons needing a special accommodation should contact the ADA Coordinator, Kim Machado, 305-579-5733x2222, kmachado@dadelegalaid.org; If hearing impaired you may call the Florida Relay Service telephone number, 1-800-955-8771 for assistance.