Fillable Legal Aid Application Fillable (Cheyenne and Arapaho Tribes)

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Legal Aid Application Fillable (Cheyenne and Arapaho Tribes)

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Office Use Only
Applicant Name ___________
Application Number: _______
Application for Legal Aid Program
Cheyenne and Arapaho Tribes – Tribal Justice Center
JUDICIAL BRANCH
LEGAL AID PROGRAM OF THE CHEYENNE AND ARAPAHO TRIBES
100 W. Black Kettle Boulevard
P.O. Box 102
Concho, OK 73022
Phone: 405-422-7450
Fax: 405-422-8259
Email: lwhitecrow@cheyenneandarapaho-nsn.gov
2 | Page
This application is confidential and is not shared with individuals outside the Legal Aid Program.
APPLICATION FOR LEGAL AID PROGRAM
I hereby make an application for legal aid services to the Cheyenne and Arapaho legal
aid program. I acknowledge that as an applicant for admission to the Cheyenne and
Arapaho Tribes Legal Aid Program I have an affirmative duty to complete the
application by responding to the questions herein truthfully, fully, and completely. I
also acknowledge that my failure to complete the application by responding to the
questions herein truthfully, fully and completely, will result in denial of the
application for admission. Also any and all supporting documentation must
accompany the application in order for it to be acknowledged as complete. No
applications will be processed unless any and all available documentation is
submitted.
1. MR. MS. ______________________________________
FIRST MIDDLE LAST
Please list any other name/ alias you have gone by
________________________________________________________________
________________________________________________________________
2. Date of birth:____/____/____ Birth City: _________ Birth State:_________
3. Address of Record and Contact Information (For internal program use only)
Residence Address: __________________________________________________
City: _________________ State: __________________ Zip Code: ___________
Home Phone Number: ________________ Cell Phone Number: _________________
Personal Email Address: ______________________________________________
Driver’s License Number: ________________________ State: _________________
Suspended: YES NO Reason: ____________________________________
Enrolled Member of Cheyenne and Arapaho Tribes: YES NO
Martial Status: SINGLE: MARRIED: SEPERATED: DIVORCED:
SPOUSE Address: ___________________________________________________
City: _________________ State: __________________ Zip Code: ___________
SPOUSE Home Number: ________________ Cell: ____________________
3 | Page
This application is confidential and is not shared with individuals outside the Legal Aid Program.
Type of case: CRIMINAL FELONY MISDEMEANOR
Charge: _____________________________________________________
Case Number: ____________________ Motion to Accelerate or Revoke: YES NO
Court and County: ______________________________________________
Next Court Date: ___________________ Type of Hearing: _________________
Bond Posted: YES NO IF YES, Amount: $_________________
Name of Bondsman: _____________________________________________
Are you the only defendant: YES NO
Names of other defendants:
____________________________________________________________
____________________________________________________________
____________________________________________________________
Description of Incident (list names of all other individuals involved):
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Have you previously had an attorney assist you with this case: YES NO
If yes, what is the reason for seeking new representation:
____________________________________________________________
____________________________________________________________
Name of previous Attorney: ________________________________________
Other Pending Legal Matters: YES NO
Case 1 Type: _____________________ Court: _________________________
Case 2 Type: _____________________ Court: _________________________
4 | Page
This application is confidential and is not shared with individuals outside the Legal Aid Program.
Are you currently on Probation: YES NO
Court: ________________________ Length of Probation: ________________
Charge: ______________________________________________________
Previous Criminal History:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Number of People in Household: ______________________
Employed: YES NO
Place of Employment: _____________________________________________
Address: ___________________________________________________________
City: __________________ State: __________________ Zip Code: _____________
Telephone: __________________________ Extension: _________________
Applicant understands that submission of this application does
not imply retaining of attorney. Once the legal aid program
reviews application and all required documentation then a
decision will be made and the applicant will be notified. For
application to be considered for approval all supporting
documentation must be attached with application at time of
submission or it will not be processed. It is the responsibility of
the application to have all documents submitted to the legal aid
programs.
Signature: _________________________________ Date: _______________
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5 | Page
This application is confidential and is not shared with individuals outside the Legal Aid Program.
Required Attachments
At the time of application for the legal aid program is submitted, the applicant shall also
provide the following additional documentation:
1. A copy of Certification of Indian Blood (CDIB)
2. A copy of a Driver’s License or State Issued ID
3. Which County is your case in? _________________
Please submit your application and supporting documents in-person at the Cheyenne
and Arapaho Tribal Justice Center located at 100 W. Black Kettle Boulevard in
Concho, OK, or by mail to P.O. Box 102 in Concho, OK 73022 or fax at 405-422-8259.
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Legal Aid Application Fillable (Cheyenne and Arapaho Tribes)

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Completed 1 May 2022

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