Guardianship Intake – Dade Legal Aid

Guardianship Intake Application

Phone

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Today's Date

Applicant Information (Proposed Guardian)

Full Name(Required)

First Middle Last Suffix

D.O.B.(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Please note that we can only serve those who have Zip Codes that pertain to Miami-Dade County.
IF your Zip Code is not in Miami-Dade County, please contact the Florida Bar Referral service at 1-800-342-8011 to obtain a private attorney.

Phone(Required)

Email(Required)

Estimated Yearly Income(Required)

Household Size(Required)

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Poverty Base

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Poverty %

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150% Threshold

You are eligible to continue.

We are sorry but your Annual Income is greater than the Federal Poverty Guidelines.
Please contact the Florida Bar Referral service at 1-800-342-8011 to obtain a private attorney.

Legal Status(Required)

Do you have any Felony Convictions?(Required)

Yes

Alleged Incapacitated Person (AIP)

AIP Name(Required)

First Middle Last Suffix

AIP D.O.B.(Required)

AIP Address (if different from applicant)(Required)

Same as previous

Street Address Address Line 2 City State ZIP Code

AIP Relationship to Applicant(Required)

Does the AIP receive SSI?(Required)

Yes

If Yes, How much per month?

AIP Legal Status(Required)

AIP Any Felony Convictions?(Required)

Yes

Reason for application. Please list the diagnosis of the Alleged Incapacitated Person:(Required)

Referral Information

Who referred you?(Required)

If referred by a Judge, please enter the Judge's name:

If you have an established case, please list case#