CSI Legal Clinic Interview Questionnaire
APPOINTMENT DATE:
CSI ID#
FIRST NAME MI LAST NAME
DATE
ADDRESS CITY STATE ZIP
PHONE #
E-MAIL ADDRESS
INTAKE WORKER ASSIGNED ATTORNEY
MARITAL
STATUS
#IN HOUSEHOLD
EMPLOYER:
MARRIED
SINGLE
SEPERATED
DIVORCED
WIDOWED
ADULTS
EMPLOYER’S ADDRESS:
SPOUSE’S NAME:
SPOUSE’S EMPLOYER:
General nature of your legal problem:
Follow Up:
HOME
CELL
WORK
ALTERNATE TELE. #
(
)
_
HOME
CELL
(
)
_
CHILDREN
Briefly describe your legal problem:
(Select as many that apply.)
OTHER:
Has a case been filed?
What country?
Case Number?
Who is/are the opposing party(ies)?
Is/are the opposing party(ies)represented by an attorney?
Have you previously seen an attorney on this matter?
If you have access to the Internet, please attach a copy of the court record in the same email.
(https://www.idcourts.us/repository/start.do)
0
0
YES
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