CASE REFERRAL: Extended Representation

Person Completing Form

Select Staff or Volunteer

StaffVolunteer

Tenant Information

First Name

Last Name

Phone

Address

Jurisdiction

Income Screening

Ask the caller about each household member, and determine each member's income. Type the total annual amount in the Total HH Income box. Then, use the income chart below to determine eligibility.

# of People in HH

Total Annual HH Income

Does the caller income qualify?

YesNo (do not submit this form)

Case Information

Court Date

Time

Case Number

Type of Case

Description

Upload any relevant file(s) the tenant has already provided

Please advise the tenant that we will review their case and check for attorney availability. If we need more information and/or can take their case, we will contact them within a few business days.

NOTE: It helps greatly if they send us their complaint, notices, lease, and any other items pertinent to the case. They can send these materials to CAPTeam@probonomd.org or to the direct email address of the staff member taking the call.

Contact Information