Self-Help E-mail Questionnaire
All fields are required
1. What is your full legal name? _________________________________________________
2. Residence Info: City:____________________ State:_______ Zip Code:____________
3. Best Contact Number:_________________________________
4. Your E-mail Address: _________________________________
5. Name of the other party or parent in your case: ____________________________________
6. Are you/were you and the other party ever married? Yes ☐ No ☐
7. Do you and the other party have minor child(ren): Yes ☐ No ☐
a If yes, please provide the child(ren)’s name(s) and birth date(s):
______________________________________________________________________
8. Has there ever been any court case anywhere involving you, the other party, and/or the
child(ren)?
a Yes ☐ No ☐
i If yes, which Court?
1 Ventura ☐
a What is the case number :____________________________
2 Another Court (insert County and State): ______________________
9. Do you have an attorney for this case? Yes ☐ No ☐
a If yes, the Self-Help Center cannot assist you.
10. Have you received assistance at a Ventura Superior Court Self-Help Center before?
a Yes ☐ No ☐
No 11. Did you look online for legal information? Yes
12. How may we assist you?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
DISCLOSURE
The Ventura Su
perior Court Self-Help Centers provide assistance to self-represented litigants through the Family
Law Facilitator’s Office, Self Help Legal Access Center, and Family Law Resource Center (“the Centers”). The
Centers help parties who have questions about their legal issues. THE
CENTERS CANNOT ASSIST YOU
IF YOU ARE CURRENTLY REPRESENTED BY AN
ATTORNEY. The Centers are NOT your
attorney and do not represent any parent or party. There is NO attorney-client relationship between you and the
Centers. Any communications between you and the Centers are not confidential. You should consult with a private
attorney if you want legal advice or to be represented in court. The Centers are not responsible for the outcome
of your case.
Completing and submitting this questionnaire is required prior to receiving assistance.
By submitting this questionnaire you agree to the above disclosure.
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the "SUBMIT FORM" button is not working please save as a PDF and email a copy to
FLF.IS.Workshop@ventura.courts.ca.gov
COURT USE ONLY: Online Services: Court E-mail:
