Intake Form

Complete the MVLP's Intake Form below. If you qualify, MVLP will contact you for additional information.

MVLP currently assists clients with civil legal matters, primarily in the following areas: uncontested divorces, emancipations, simple wills, adoptions, guardianships, name changes, birth certificate corrections, conservatorships, and felony expungement matters.

MVLP DOES NOT HANDLE CRIMINAL MATTERS.

ROUND TO THE NEAREST DOLLAR WHEN RESPONDING TO FINANCIAL INFORMATION. (e.g. $500.00 should be 500). FAILURE TO ROUND TO THE NEAREST DOLLAR WILL RESULT IN YOUR FORM NOT BEING PROCESSED.

What is your legal matter? (Select an option below)

Choose case type

Divorce

Do both parties (parents) agree to resolve this legal matter?

If you and adverse party have children together, what are the children's ages?

If there are children, is there a child support order in place?

What type of property do you have together with "adverse party"? *

How long has the child lived with you?

Type of Divorce:

If your legal matter is an uncontested divorce, how long have you been physically separated?

Date of Seperation

Felony Expungement

Are you currently incarcerated?

Yes

If you are currently incarcerated, you are unable to receive an expungement. Please wait until after you have completed the terms of your sentence.

Was the charge non-adjudicated, remanded, dismissed or not prosecuted?

Yes

If you are currently incarcerated, you are unable to receive an expungement. Please wait until after you have completed the terms of your sentence.

Were you convicted of charges in Mississippi?

Are your charges federal?

Are there any new charges pending?

Have you been convicted in any other states?

If your matter was a felony conviction, was the conviction for one of the following crimes?

If your charge is not listed, what is the name of your charge?

If you have your Abstract or Sentencing Order, Please upload it here.

Guardianship

Does the natural mother agree to the guardianship?

Does the natural father agree to the guardianship?

What is the natural mother's name?

What is the natural father's name?

Is either parent incarcerated?

What is your relationship to the child?

How long has the child lived with you?

Reasons for the guardianship:

If you have your Abstract or Sentencing Order, Please upload it here.

School records from last school attended, Please upload it here.

Death certificate of parent (if applicable), Please upload it here.

Contact Name *

Phone Number *

Email *

Are you a U.S Citizen?

What is your date of birth *

What is your race? *

Do you identify as a:

Address

Address1

County

City

Do you own checking account?

Do you have a savings account?

How much is in checking? *

How much is in savings? *

How many adults live in your household?

How many children live in your household? *

What is your household monthly income? $ *

Household Monthly Income Detail

Wages *

Disability *

Food Stamps *

Unemployment *

TANF *

Pension/Retirement *

Family/Friends Assistance *

Other *

Do you own a home?

Do you own a car?

What is your home value? *

What is the value of your car? *

Household Monthly Expenses

Child Support *

Medical *

Rent/Mortgage *

Name of adverse Party *

Nursing Home *

Medical Home Care *

Child Care *

Taxes *

Transportation *

Employment Related *

Statement of Facts

If seeking a divorce, Do you and the "adverse party" have children together?

Do you and adverse party have any property together?

Please provide a Statement of Facts of your legal matter to the best of your ability: *

Retainer Agreement

I hereby request that the Mississippi Volunteer Lawyers Project (MVLP) represent me and do hereby certify that I do not have enough money or property to hire a private lawyer. I will promptly tell MVLP of any change in my address, telephone number, income, or household size. I have provided MVLP with valid, true and correct verification of my income. I understand that I will be able to continue receiving services from MVLP as long as my income and assets are at or below the established eligibility guidelines, otherwise, MVLP might have to end this agreement and stop representing me.

I understand that MVLP does not charge legal fees for its services, but that I am responsible for paying a filing fee to the volunteer attorney who handles my case if MVLP is able to locate one for me. I understand that I may also be responsible for paying service of process fees, publication fees, special master fees, guardian ad litem fees and any other fees that may be incurred during the course of MVLP’s handling of my case to my volunteer attorney. I agree that I will not settle my case or problem without first informing MVLP. I will not communicate with any other person, agency, organization, or institution about my problem after MVLP has agreed to accept my case unless MVLP tells me that it okay to do so.

I understand that MVLP will work vigorously on my behalf and will keep me regularly informed about the status of my case. I agree to cooperate with and assist MVLP in my case, including and not limited to providing complete and truthful information when requested, being present at all scheduled hearings and meetings, and responding promptly to phone calls and letters from MVLP.

I acknowledge that I understand the terms of this agreement, and have been given an opportunity to ask questions and receive an explanation regarding any part of it I did not understand. It is understood and agreed that this agreement is only valid when signed by both parties (the client and MVLP representative). A staff member may need the approval of his/her immediate supervisor before MVLP can accept my case and sign this agreement. This writing represents the entire agreement between the parties and cannot be amended or modified except in writing signed by both parties.

I have read the above information and it is a true and accurate statement of my financial situation and the facts concerning my problem. I certify that I am a citizen of the United States of America.

Signature Date: *

Submit