Fillable Modest Means Program - PUBLIC APPLICATION FORM

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Modest Means Program - PUBLIC APPLICATION FORM

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PLEASE READ BEFORE COMPLETING APPLICATION:
Oregon lawyers created the Modest Means Program to help moderate-income Orego-
nians find affordable legal assistance. The program is intended to help those who earn
too much to qualify for legal aid, but who cannot afford traditional legal fees. Modest
Means lawyers have agreed to charge reduced rates for legal work provided to clients
referred to them through the program. There is no grant, fund or subsidy that makes
up the difference between the lawyers’ regular rates and the Modest Means Program
rates. The lawyers DJUHHWRFKDUJHUHGXFHG rates because they believe in the mission
of this program and want to help.
Types of Matters: Modest Means lawyers only handle certain kinds of family law, crim-
inal defense, landlord/tenant and foreclosure matters. If the specific area of law with
which you need help is not listed on the application, then it is not part of the program.
To Apply: Before you can be referred to a Modest Means lawyer you must apply and
be pre-qualified. To apply, you must complete the application form and return it to us by
fax, mail, or email (legalhelp@oregonstatebar.org--PDFs ONLY). You can call the
number listed above for the application form or download it from the bar’s website at
www.oregonstatebar.org.
Please do not forget to sign and date your application. Your application will not be
processed if you do not fill out your application completely, or fail to sign or date it. Do
not include any other documents with your application – any documents you send to
us will not be returned. We process most applications within one (1) business day. If
you provide an email address, please check your email account for your referral or for
questions that we may have about your application.
Eligibility: Eligibility is based on the type and location of your legal matter, your in-
come and assets, your location, and availability of participating lawyers in your area. It
is important to understand there are a limited number of lawyers in the program, and
there may not be a Modest Means lawyer in your county. We cannot guarantee that we
will have a lawyer for you even if you pre-qualify. In addition, your legal matter must be
in Oregon and both parties must live in Oregon to be eligible for the Modest Means
Program. If both parties do not live in Oregon you will not be referred to a Modest
Means Program lawyer even if your legal matter is in Oregon.
(continued on next page)
Modest Means Program - PUBLIC APPLICATION FORM
Oregon State Bar, Modest Means Program, PO Box 231935, Tigard, OR 97281-1935
Voice: (503) 684-3763 (800) 452-7636 Fax: (503) 431-6444
Modest Means Program - PUBLIC APPLICATION FORM
Oregon State Bar, Modest Means Program, PO Box 231935, Tigard, OR 97281-1935
Voice: (503) 684-3763 (800) 452-7636 Fax: (503) 431-6444
Qualification Process: You will be contacted by email or telephone after your application has been
reviewed. If you pre-qualify, we will give you the name and phone number of a lawyer in your area
for you to contact. The lawyer to whom we refer you will receive a copy of your application and may
ask additional questions to confirm your eligibility for the program. The lawyer has the final say as to
whether or not you qualify for the program.
Initial Consultation: If you are referred to a Modest Means lawyer, you will need to call the lawyer to
make an appointment for your initial 30-minute consultation. Your consultation will cost no more than
$35, payable at the time that you meet with the lawyer.
Hiring a Modest Means Program Lawyer: Whether or not you hire the lawyer to represent you after
your initial consultation is a decision for both you and the lawyer to make. We cannot guarantee that
a lawyer will agree to take your case. All Modest Means lawyers who participate are volunteers and
have the right to choose whether or not they will accept your case.
Legal Fees & Costs: Lawyers who are willing to accept Modest Means clients have agreed to
charge no more than $60, $80, or $100 per hour for any services they provide beyond the initial $35,
30-minute consultation. Which hourly rate will apply to you depends upon your income and assets.
You will be asked to pay a retainer (deposit against fees) up front. The retainer amount will be
determined by the lawyer following your initial consultation. The amount of the retainer will depend on
the lawyer's esti-mate of how much work will be required to complete your case. You will also be
charged for any court fees and other direct costs, including phone charges, photocopy expenses, etc.
The Modest Means Program is not a legal aid program and it is not a pro bono (free) program. Y
ou
must be able to pay $35 for an initial consultation, plus $60/80/100 per hour (as applicable) for any
work done beyond the initial consultation. In order to be referred to a Modest Means Program
lawyer, your application must demonstrate that you have the ability to pay these fees. If someone will
be helping you pay for your legal fees and costs please explain that on your application. If you are
unable to pay these fees and costs, you should contact the legal aid office in your county of resi-
dence. The Oregon State Bar does not have a referral program for pro bono (free) lawyers.
Portland Metro Area: (503) 684-3763
Elsewhere in Oregon: (800) 452-7636
Fax: (503) 431-6444
INSTRUCTIONS: Please print clearly or type. Please sign and date your application. Your application will not be
processed if you do not fill out your application completely, or fail to sign or date it. Do not include any other
documents with this application – any documents you send to us will not be returned. We process most
applications within one (1) business day. If you provide an e-mail address, please check your e-mail account for
your referral or questions we may have about your application. Fax or mail your completed application to us:
OREGON STATE BAR MODEST MEANS PROGRAM, P.O. BOX 231935, TIGARD, OR 97281-1935
FAX: (503) 431-6444 EMAIL: legalhelp@oregonstatebar.org
Please note: All infor
mation
provided will be treated as confidential communications made for the purpose of facilitating the rendering of
professional legal services to you. We will preserve the confidentiality of all such information unless otherwise required by law.
First Name Last Name
Address
City Zip Code
Phone Number E-mail Address [If you provide an e-mail address that is how you will be notified.]
Family Law (No Appeals)
Divorce/Separation Misdemeanor
Custody/Parenting Time Lesser Felony
Support/Modification Major Felony
Juvenile/DHS/CSD/SCF issues DUII/DWS
Paternity Parole/Probation
Restraining Orders Expungement
Process Questions
Domestic Violence
Real Property (No Appeals)
Grandparent/3
rd
Party Rights Foreclosure
Spousal Support Landlord-Tenant (Tenant)
Coaching (General) Landlord-Tenant (Landlord)
Document Review Mobile Home (Tenant)
Mobile Home (Landlord)
In which city/county do you need assistance?
When is your next court date (if applicable)?
What is the name of the opposing party?
Does the opposing party have an attorney?
If yes, what is the attorney’s name?
Are both parties in Oregon?
Have you already consulted with an attorney?
If yes, what is the attorney’s name?
Reason you are looking for another attorney:
Criminal Law (No Capital Charges or Appeals)
Modest Means Program - PUBLIC APPLICATION FORM (Page 1-3)
Oregon State Bar, Modest Means Program, PO Box 231935, Tigard, OR 97281-1935
Voice: (503) 684-3763 (800) 452-7636 Fax: (503) 431-6444
First Name Last Name
Phone Number E-mail Address
How many people live in your household including you? _____Adults
_____Children
Marital Status: Unmarried or Widowed Married Separated Divorced
Do you and your spouse live in the same household?
Yes No N/A
Do you rent or own the home in which you are living?
Rent Own
Do you own any land or a house, even if you do not live there?
Yes No
Make of each vehicle owned Year Model Value (est.)
1. $
2. $
Gross Income (before taxes)
(per month)
Liquid Assets
Wages:
$
Checking Account Balance
$
Spousal Support:
$
Savings Account Balance
$
Child Support:
$
Money Market/Other Account
$
Veteran's Benefit:
$
Total Liquid Assets:
$
Unemployment:
$
SSI/SSD:
$
Non-liquid Assets
TANF (not SNAP):
$
Amount in Retirement Plans (401k),
Public Benefits, Aid, SNAP:
$
mutual funds, securities, bonds, etc.:
$
Retirement/Investment Income:
$
Other non-liquid assets (please specify):
Other income (please specify):
$
$
Total Gross Income:
$
Total Non-liquid Assets:
$
Special Expenses & Debts
1
(Per Month)
Partner/Family Members in Household :
(Gross Income
per month)
Medical
2(see explanation below)
:
$
Child Care
3(see explanation below)
:
$
Name Relationship
Transportation
4(see explanation below)
:
$
$
Spousal Support:
$
$
Child Support:
$
If not already listed above, what is your
spouse's gross income per month?
Total Special Expenses/Debts:
$
(Please estimate, if separated.)
$
1
Ordinary expenses that most people have (such as rent, food, utilities) are considered in the basic income calculations and should not be listed here.
Other personal and discretionary expenses such as car payments, car insurance, and credit card debts are not considered under our guidelines.
2
“Medical” refers to medical expenses that are not covered by insurance.
3
“Child Care” refers to costs incurred while a parent is at work.
4
“Transportation” refers to basic transportation costs to get to and from work (bus tickets, gas).
Have you submitted an application before? Yes No If so, when?
By signing below, I certify that all information provided is true and correct to the best of my knowledge. I understand and
agree that if I provide inaccurate, incomplete, misleading or false information on this application, or to any Modest Means
Program attorney, I may be disqualified from participation in any and all Referral & Information Services programs,
including the Modest Means Program.
Signature
B ELOW I S FOR OFFICE USE ONLY
Eligible:
Y N
Tier: 1 2 3 $ /hour Notes:
(rev. 5/18
A household consists of people with whom you share income and expenses, who live in your home at least 50% of the time.
Modest Means Program - PUBLIC APPLICATION FORM (Page 2-3)
0
0
0
0
First Name Last Name
Phone Number E-mail Address
Briefly describe the legal matter for which you are seeking assistance:
Modest Means Program - PUBLIC APPLICATION FORM (Page 3-3)
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Completed 11 May 2021

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