Apply for Services * Indicates a required field Welcome to Allegany Law Foundation, Inc. (ALF). You must provide the information listed below, so you may want to gather it before you start: Income information for all household members The value of your house, if you have one The value of your car, if you have one How much you have in your checking or savings account, or any investment accounts PLEASE NOTE: You are NOT a ALF client until ALF tells you that your case has been accepted. There is no attorney-client privilege with any ALF staff or volunteer attorney until you and your attorney have signed a representation agreement. ALF may search public and private databases for potential legal issues you may have. * Agree Where did your legal problem happen? * Allegany CountyCarroll CountyHarford CountySt. Mary's CountyAnne Arundel CountyCecil CountyHoward CountySomerset CountyBaltimore CityCharles CountyKent CountyTalbot CountyBaltimore CountyDorchester CountyMontgomery CountyWashington CountyCalvert CountyFrederick CountyPrince George's CountyWicomico CountyCaroline CountyGarrett CountyQueen Anne's CountyWorcester County ALF assists residents of Allegany County. If you do not live in Allegany County or your legal problem happened outside of Allegany County, please visit (additional resources page) or call our phone intake at (301) 722-3390 between 9 am and 12 pm, Monday through Thursday. Hearing Date Do you have a hearing scheduled less than 30 days from today? * YesNo Given the short time frame for this kind of case, please do not complete the online intake. Instead, please call our phone intake at (301) 722-3390 between 9 am and 12 pm, Monday through Thursday. Type of Problem ALF assists with some, but not all civil legal matters. Select legal problems * ---Advance DirectiveBankruptcyChild CustodyCollection of DebtConsumer DisputesContract DisputesCriminal Record ExpungementDivorceForeclosureLandlord/TenantPower of AttorneyProperty Tax SaleEstate Administration Please include the name and ages of the children involved If your legal problem is not listed, please call our phone intake at (301) 722-3390 between 9 am and 12 pm, Monday through Thursday or go to additional resources. Household Income HOUSEHOLD INCOME. Financial eligibility is based on Household Income, Household Size, and Assets. ALF cannot provide a free attorney to any client who exceeds the Household Income Eligibility Guidelines. Failure to provide complete and accurate household information may result in denial of placement services. “Household” is your family unit, all persons sharing both physical and financial living arrangements with you. Your spouse or domestic partner must be included in your household if you share a residence. Every household must list all income, public benefits, and other means of support. I understand and Agree * I understand Financial Information Provide the number of adults and children in your household. If there are no children in your household, enter 0. Number of Adults Number of Children Household Income: You must fill in at least one monthly income amount or select 'No Income' if no one has any income. ENTER ONLY MONTHLY AMOUNTS. For example: "Employment, $425, spouse." 1 Type of Income * ---EmploymentRentalsDividendPartial EmploymentOther (please specify in notes) Amount * Relationship/Notes * 2 Type of Income ---EmploymentRentalsDividendPartial EmploymentOther (please specify in notes) Amount Relationship/Notes 3 Type of Income ---EmploymentRentalsDividendPartial EmploymentOther (please specify in notes) Amount Relationship/Notes 4 Type of Income ---EmploymentRentalsDividendPartial EmploymentOther (please specify in notes) Amount Relationship/Notes 5 Type of Income ---EmploymentRentalsDividendPartial EmploymentOther (please specify in notes) Amount Relationship/Notes 6 Type of Income ---EmploymentRentalsDividendPartial EmploymentOther (please specify in notes) Amount Relationship/Notes 7 Type of Income ---EmploymentRentalsDividendPartial EmploymentOther (please specify in notes) Amount Relationship/Notes 8 Type of Income ---EmploymentRentalsDividendPartial EmploymentOther (please specify in notes) Amount Relationship/Notes 9 Type of Income ---EmploymentRentalsDividendPartial EmploymentOther (please specify in notes) Amount Relationship/Notes 10 Type of Income ---EmploymentRentalsDividendPartial EmploymentOther (please specify in notes) Amount Relationship/Notes Asset Information Below, enter a dollar amount for each asset type listed. Enter a "0" if applicable. Please DO NOT list any expenses including rent, car or insurance payments. If you own a business , please put the name of the business in the asset notes field. Asset Amount Note Cash Checking Savings Home Other Property Car Other Car Stocks, Bonds, or CDs Business Other Enter a value under Home if you or another household member is on the deed to the home. Enter a value under Other Property if you or another household member owns additional property, such as land, a rental property, vacation home, or time share. Don't forget to list all properties, including second properties, time shares, boats, campers, etc. If you are unsure of the value of your home, you can click here to look it up at the Maryland Department of Assets & Taxation. If you are unsure of the value of your car, you can click here to visit Kelley Blue Book to determine an estimated value. I certify that the information provided is true and exact to the best of my knowledge. * Agree Personal Information First Name * Middle Name Last Name * Address (include Lot #/Apt #) * City * County * Allegany CountyCarroll CountyHarford CountySt. Mary's CountyAnne Arundel CountyCecil CountyHoward CountySomerset CountyBaltimore CityCharles CountyKent CountyTalbot CountyBaltimore CountyDorchester CountyMontgomery CountyWashington CountyCalvert CountyFrederick CountyPrince George's CountyWicomico CountyCaroline CountyGarrett CountyQueen Anne's CountyWorcester County State * ---ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMTNENVNHNJNMNYNCNDOHOKORMDMAMIMNMSMOPARISCSDTNTXUTVTVAWAWVWIWY Zip * Phone Numbers and Email Address If you do not have a Home Phone, list your mobile phone number as your home phone. Use the "Safe" checkbox to indicate which phone numbers are okay for us to call. Home Phone Phone # Note Safe? safe to call Business Phone Phone # Note Safe? safe to call Mobile Phone Phone # Note Safe? safe to call Email (if none leave blank) Client Statistics Information in this section will be used for demographic purposes only and will in no way affect whether or not ALF is able to provide you with an attorney. Gender * MaleFemale Date of Birth * Age Disability YesNo Highest Education Level Less than high schoolHigh school diploma or equivalentSome college, no degreePostsecondary non-degree awardAssociate’s degreeBachelor’s degreeMaster’s degreeDoctoral or professional degree Race American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhite Language EnglishSpanishOther Veteran YesNo Are you a homeowner YesNo Is there a person, orginization, or business you are having a problem with YesNo Opposing Party Info Please fill in as much information as you can about the party you are in dispute with First/Business Name Last Name DOB/Business Type Address (include Lot #/Apt #) City County Allegany CountyCarroll CountyHarford CountySt. Mary's CountyAnne Arundel CountyCecil CountyHoward CountySomerset CountyBaltimore CityCharles CountyKent CountyTalbot CountyBaltimore CountyDorchester CountyMontgomery CountyWashington CountyCalvert CountyFrederick CountyPrince George's CountyWicomico CountyCaroline CountyGarrett CountyQueen Anne's CountyWorcester County State ---ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMTNENVNHNJNMNYNCNDOHOKORMDMAMIMNMSMOPARISCSDTNTXUTVTVAWAWVWIWY Zip Phone # Relationship Facts About your Legal Issue If you have a court case number please enter it. If you aren’t sure of your case number, you can click here to search Maryland Judiciary Case Search. Court Case Number If you have a hearing scheduled pertaining to your legal matter, please enter it. Court Date Facts of Case Briefly explain the situation and what happened up to now. * What results are you seeking? * Have you been represented by another attorney in the past? If so, please enter that attorney's name, the dates he or she represented you, and the reason the attorney no longer represents you. * Are there any existing agreements between you and the party opposing you? * Certification I understand that Allegany Law Foundation, Inc. (ALF) is a volunteer referral program and does not guarantee it will find an attorney who will accept my case. You are not an ALF client until ALF notifies you that your case has been accepted. There is no attorney-client relationship with any ALF staff or volunteer attorney until you and your attorney have signed a representation agreement. I understand that after my attorney accepts my case, my relationship with my attorney will be governed by the agreement between myself and my attorney. I understand that once ALF refers me to an attorney, the attorney may refuse to accept my case if my case is deemed to have no merit; accepting my case would involve violation of law or Rules of Professional Responsibility; I am not prepared or able to pay the court costs or other expenses necessary for proper handling of my case; or any other legitimate reason. I understand that failure to keep appointments or failure to cooperate with the attorney or staff at Allegany Law can result in services being discontinued and I may be ineligible for services in the future. I understand that ALF will seek to place my case with an attorney who will not charge me for representation, and that my attorney will seek waivers of fees and court costs for which I am eligible. I further understand that I am responsible for the payment of any and all non-waivable court costs, advertising fees, paternity tests, or other fees that may arise in association with my case. I authorize ALF to share any and all of my personal and financial records with my assigned attorney, law office staff, or legal or social service agencies to whom my matter is referred by ALF. I authorize my attorney to disclose to ALF any information that my attorney learns about my financial circumstances. I hereby permit and instruct any attorney, law office staff, legal or social services agency to which this matter is referred by ALF to respond by phone or in writing to requests made by ALF for information about the facts, progress or outcome of my case. I understand that ALF may check the accuracy of the information I have provided about my household, assets, and income. If my financial circumstances improve during the time I am represented by an attorney, I will immediately inform ALF and my file will be reviewed for continued services. If I do not qualify based on eligibility criteria, I agree to negotiate a private fee with the attorney for continued representation. I understand that ALF may close my case at any time upon learning that the information provided is incorrect. I authorize ALF to release the information provided during the application and intake process to persons checking to see that ALF has complied with the restriction on its funding. I release Allegany Law Foundation, Inc. and its officers, directors, members, and employees from any and all claims, losses, and liability arising out of any referral made by or through any of Allegany Law Foundation’s programs. I authorize ALF to contact me through all communication outlets, including but not limited to mail, phone, email and text, unless I notify ALF that I do not want to receive that communication type and I agree to keep ALF informed of any changes to my contact information I certify that the information I have provided to Allegany Law Foundation, Inc. is true and exact to the best of my knowledge. I certify that I have read and agree with the terms and conditions stated above. Further, I understand if it is discovered that I have falsified this document, I may become ineligible for attorney placement with the Allegany Law Foundation, Inc. * agree