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Family Intake

Section A: Basic Information Please provide the following basic information, which will be used to perform a conflicts check. If we are unable to assist you based on this information, we will not review and will delete from our systems the information in the following sections. * indicates a required field.

WhiteBlackHisp./LatinoAsianPacific Island.Native Amer.Biracial/MultiracialPrefer Not to AnswerOther
FemaleMaleGender NonconformingPrefer Not to AnswerOther:
By applying for legal assistance online you are agreeing to be contacted by all methods. If you prefer not to be contacted by these methods please call the intake line at 202-628-1161 option 2.











Section B: Household Income Legal Aid generally serves individuals whose household income is at or below 200% of the Federal Poverty Guidelines. For some types of cases, we may serve individuals whose household income is between 200% and 300% of the Federal Poverty Guidelines. Please provide the following basic information about your household income so that we can determine whether you are eligible for our services. If we are unable to assist you for any reason, this information in this section will be deleted from our system.

Type of Income
Amount
Frequency
Type of Income
Amount
Frequency
Type of Income
Amount
Frequency
Type of Income
Amount
Frequency
Type of Income
Amount
Frequency
Section C: Information about Your Legal Matter Please provide the additional information below describing your legal matter. If we are unable to provide you with legal representation on this matter for any reason, the information in this section will be deleted from our system.

Domestic violenceChild custody & visitationChild supportDivorce
Domestic Violence
A. Safety Planning
1. Are you living with the abuser and/or in immediate danger? YesNo
If you are in immediate danger, please call 911 or visit a Domestic Violence Intake Center and consider developing a safety plan.
If you do not think you are in immediate danger but are still living with the abuser, please consider developing a safety plan.
2. Is this computer used by anyone you want to keep from seeing your search history, including that you are seeking legal help? YesNo
Please be aware that internet browsers track activity, such as search history and pages visited, and it is possible that your abuser could access this information. We recommend that you practice safe internet tips like clearing browser history, using private browsing, or accessing the internet from a friend's house or library.
B. Status of Case
1. Do you have a current Civil Protection Order (CPO) case in D.C. court? YesNo
a. Is there a court date set? YesNo
i. When is the next court date? ii. What is the Courtroom number? iii. What is the Case number? iv. When was the case filed? v. Have any continuances been granted previously? vi. Is opposing party represented by counsel? Please list any information regarding opposing counsel.
b. Who filed for the Civil Protection Order (CPO)? MeOther Party
i. Do you admit or deny the allegations listed in the petition? ii. What is your side of the story?
i. What would you like the court to do in your case? ii. If you want the other party to leave the home, who is on the lease/mortgage to the home? iii. If you want the other party to reimburse you for damages, do you have proof/evidence of the damages? What was damaged? What was the cost?
c. Were there any witnesses present during any of the domestic violence incidents? YesNo
i. What are their names and phone numbers, if you have them?
2. Are there any other current cases involving you and the other party? If so, please list the types of cases and, if you know them, the case numbers. 3. Have there been any prior cases of any kind between the two of you? (past CPOs, custody / visitation, child support, divorce, etc.) If so, please list the types of cases and, if you know them, the case numbers. 4. Do you and the other party have any children together? YesNo
a. What are their names and dates of birth or ages? b. Where have the children been living and how long have they lived there?
5. Will child custody/visitation also be an issue between you and the other party in this CPO case? YesNoNot Sure
a. What do you want to happen? b. Do you want to talk to someone about going to court for custody as well? YesNo
C. Temporary Protection Order (TPO) 1. Has a Temporary Protection Order (TPO) been granted? YesNo
a. To whom? b. What relief was granted in the TPO? c. When does the TPO expire? d. Has TPO already been extended in the past?
D. History of Domestic Violence
1. If you have already filed for a protection order, please summarize the incidents you included in your petition. If you have not filed, please list all incidents of domestic violence starting with the most recent incident. Include dates of the incidents. In each of the incidents, please indicate if you were the perpetrator, i.e. started the incident, and/or if you acted in self-defense. 2. Did anyone require medical or hospital treatment as a result of any domestic violence incidents? YesNo
a. When and where? b. What were the injuries?
3. Were there any witnesses to any of the above incidents? YesNo
a. What did the witness/witnesses see?
4. If you have children, were any present during any domestic violence incidents? YesNo
What was their reaction?
5. Were weapons or any other objects used in the course of any domestic violence incidents? YesNo
a. What was the weapon/object? b. How was it used? c. How many times did this occur?
6. Was anyone under the influence of drugs or alcohol during any incidents of domestic violence? YesNo
a. What was the drug used? b. How often is that drug consumed?
7. Has 911 ever been called? YesNo
a. When and where? b. Who called them?
8. Have the police ever been involved in any of the domestic violence incidents? YesNo
a. When and where? b. Was a police report taken afterwards? YesNo
i. When and where? ii. If you have it, what is the name and information of the reporting officer?
c. Was anyone arrested as a result of the domestic violence? YesNo
i. When and where? ii. Who was arrested?
9. Has there ever been a criminal case papered? YesNo
a. When and where? b. Against whom? c. Was there a conviction?
10. Is there anything else we should know about your case?
IMPORTANT DOCUMENTS IN DOMESTIC VIOLENCE CASES
If you have any of the following documents, please upload here, e-mail (to onlineintake@legalaiddc.org) or fax them to 202.727.2132 (Attn: Online Intake)
A. Any and all family court papers related to you, other party and your children
B. Any and all criminal court papers related to you and/or the other party
C. Any evidence of domestic violence, including but not limited to:
1. Text/voice messages
2. Emails
3. Social media messages
4. Pictures of injuries or damage to property
5. Hospital records
6. Police reports (or police report information)

Child Custody and Visitation
NOTE: If you are not the parent (biological or adoptive) to the children at issue in this case, then please do not proceed with this online application. Please call our Intake Unit at 202.628.1161 for more information.
Case Status
1. Do you have a current custody/visitation case in DC Court? YesNo
a. When is the next court date? b. Who filed the case? c. What do you want to happen? Why? d. What does the other party want? Why?
2. Is there an existing custody order already in place? YesNo
a. Where do the children live now? b. What does the current order say about legal and physical custody? c. Are you and the other party following the order? YesNo
i. What is the actual arrangement now?
d. How long has the current arrangement been going on? e. Have there been any other types of cases of any kind between you and the other party? (e.g., domestic violence, custody/visitation, child support, divorce, etc.) f. Are you asking for child support or a divorce in the same case as custody? g. Do you want to modify or change the current order? YesNo
i. Why?
3. Please briefly describe the custody/visitation problem you are experiencing.
Background Info
1. What are the names and dates of birth for all of the children in the case? 2. What are the names of all the other adults and children living with the children in this case?
3. Do the children live in DC? YesNo
a. How long have they been away from DC?
a. How long have they lived at their current home?
4. Do the children have any special needs? 5. Is there any question about paternity of the children in the case? If so, why? 6. Is there a history of domestic violence / CPOs between you and the other parent? YesNo
Please describe the domestic violence.
7. What is the criminal history of you and the other parent? 8. What is the drug or alcohol abuse history for you and the other parent? What, if any, treatment? 9. What is the mental health history for you and the other parent? What, if any, treatment? 10. Have there ever been allegations of abuse or neglect against you and/or the other parent? 11. Did something happen recently that caused the custody case to start? 12. If this case is a Motion to Modify, when was the last custody order put in place? What did that order say? What happened to cause the new case? 13. Is there anything else we should know about your case? IMPORTANT DOCUMENTS IN CUSTODY/VISITATION CASES
If you have any of the following documents, please upload them here, e-mail (to onlineintake@legalaiddc.org) or fax them to 202.727.2132 (Attn: Online Intake)
A. Any and all family court papers related to you, other party and your children
a. This includes home studies, psychological evaluations, etc.
B. Any and all criminal court papers related to you and/or the other party
C. Any written correspondence between you and the other party
D. Social media messages by either party about the child or showing parenting concerns
E. Any school, medical or other records you think are relevant
Child Support
I. Background Info
A. Names and dates of birth of all children for whom support is sought. B. Do all children live primarily with you or the other party – or is their time split equally between both of you? C. Do you or the other party receive TANF or SSI/SSDI? D. Has one of the parties or CSSD (the Child Support Services Division of the Office of the Attorney General) started a case? Who started the case? E. Are there any other current or prior cases involving the same parties and child(ren) (e.g., CPO, custody/visitation, divorce)? II. Paternity
A. Do you or the other party have questions about biological paternity? Why? B. Who is listed on the birth certificate? Is there a DNA test? Were the parties married? III. Child Support Questions
Do you want to: Start a child support caseIncrease child support orderTry to enforce an existing child support orderLower/Stop existing child support order
1. Is there currently a child support order? YesNo
a. Is the case in DC? YesNo
Please stop here and call our Intake Unit at 202.628.1161 for a possible referral.
i. When was it put in place? ii. Has anything changed since the current order was issued? iii. Is it more than 3 years old?
2. Is the other parent working? YesNo
a. Where? b. How long? c. How much do they make?
3. Have you filed in court a Petition for Child Support or Motion to Modify an Existing Order?
1. Is the case in DC? YesNo
Please stop here and call our Intake Unit at 202.628.1161 for a possible referral.
2. How much is the current order? 3. Has a Motion for Contempt already been filed? 4. How much does the other parent owe in child support (in total)?
1. Is the case in DC? YesNo
Please stop here and call our Intake Unit at 202.628.1161 for a possible referral.
1. What is the current order for? 2. When was it put in place? 3. What has changed since the order was put in place that makes it hard/impossible to pay the order? 4. Is order more than 12 years old? 5. Has a Motion to Modify already been filed?
Is there anything else we should know about your case?
IMPORTANT DOCUMENTS IN CHILD SUPPORT CASES
If you have any of the following documents, please upload them here, e-mail (to onlineintake@legalaiddc.org) or fax them to 202.727.2132 (Attn: Online Intake)
A. Any and all court papers regarding child support for the child(ren) at issue
B. Acknowledgement(s) of paternity or birth certificate(s) for child(ren) at issue
C. Proof of expenses for health insurance, childcare, and extraordinary expenses
D. Agreements between parties
E. Correspondence between parties
F. Social media of either party showing living expenses or income
Divorce
A. Marriage Info
1. Date and place of marriage 2. Where do you and the other party live now? 3. Have you and your spouse separated? YesNo
a. When did you separate? b. Was the separation agreed upon by you and your spouse? YesNo
4. Is there any history of domestic violence between the two of you? YesNo
Please explain. NOTE: If you have already explained this elsewhere in this form, please skip this question.
B. Divorce Info
1. Have you or the other party filed for divorce? If so, has there been service? 2. Why do you want to get divorced? What happened? 3. Do you both have minor children together? YesNo
If custody and/or child support will be at issue, please scroll back to the top of the page and select the appropriate sections to complete those intakes.
4. Do you and the other party have marital property (e.g. house, car, bank accounts, retirement or pension funds, debts—credit cards, mortgage)? YesNo
a. What marital property would you want the court to distribute?
5. Are you or the other party asking for alimony? 6. What is your income and the income of the other party? 7. Is there anything else we should know about your case?