General Intake Form
Please complete the form below to request more information.
Contact Information
First Name
Last Name
Email
80 characters left.
Phone Number
What is your preferred method of contact? (phone or email)
Home Address
Address Line 1
Address Line 2
City
Zip/Postal Code
5 characters left.
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
County
Business/Nonprofit Name
What question(s) and/or issues do you need help with from LegalCORPS?
Which LegalCORPS Program(s) are you interested in?
Business & Entrepreneurs
EOC
Inventors
Nonprofit Organizations
Household Income
-
We ask this because some of our programs require that our clients make below a certain level of income.
Total gross MONTHLY household income
$
.00
Household income is a measure of the combined incomes of all people sharing a particular household or place of residence. It includes every form of income, e.g., salaries and wages, retirement income, government benefits, etc.
How many adults live in your household?
2 characters left.
How many children (under age 18) live in your household?
2 characters left.
How did you hear about LegalCORPS?
Flyer/Brochure
Other Organization or Event
Social Media
Friend/Family
Internet/Web Search
Partner Referral
Other
Send me LegalCORPS updates, information relevant to my business/nonprofit/invention, and newsletters via email
Demographics
(
optional)
Birth Year
4 characters left.
Gender
Male
Female
Non-Binary
Prefer not to say
Other
Other Gender
Race/Ethnicity Self-Identification
African American/Black
Asian/Pacific Islander
Native American/American Indian
White
Biracial
Multiracial
Other
Prefer not to say
Other Race/Ethnicity
Do you identify as Latino/Hispanic Origin?
Yes
No
Prefer not to say
Do you consider yourself an immigrant?
Yes
No
Prefer not to say
Are you a veteran?
Yes
No
Prefer not to say
Do you consider yourself to have a disability?
Yes
No
Prefer not to say
Screening Type
Contact Information