The Intake Application is used for requesting legal services for eligible applicants who live in, or whose civil legal problem is in any of the following Virginia counties or cities:

Alexandria City	Fredericksburg City	Northumberland
Arlington	King & Queen	Orange
Caroline	King George	Prince William
Culpeper	King William	Rappahannock
Essex	Lancaster	Richmond County
Falls Church City	Loudoun	Spotsylvania
Fairfax	Madison	Stafford
Fairfax City	Manassas City	Westmoreland
Fauquier	Manassas Park

This intake is for civil legal services by Legal Services of Northern Virginia, Inc. (LSNV).

If your legal problem is a criminal or traffic matter, click here.

LSNV Legal Aid Intake Process

Step 1 Fill out and submit this Online Application

Step 2 One of our Intake Paralegals will contact you by phone as soon as possible (usually within 3 business days) to conduct an eligibility Interview

Step 3 If you are eligible for services, you will have a consultation with an attorney or paralegal

Fill out this application and click on the Submit button to determine if you are eligible to consult with an attorney or case-handler paralegal at LSNV.

Within 3 business days after submitting the Intake Application you will be contacted by an Intake Paralegal for additional information such as your gross monthly income and your citizenship status.

If you have not been contacted within 3 business days or are concerned about using a computer to make this request, please use our telephone intake by calling telephone numbers (703) 532-2525 or 1- 866-534-5243 (toll free). Our office hours are Monday through Friday from 9:00 a.m. to 5:00 p.m. 

Privacy Notice

We cannot guarantee your privacy for any information you send us by e-mail, and we accept no responsibility for information that does not reach us because of a telecommunications, computer system or Internet problem.

Representation Information

By submitting this Intake Application, you agree that you are only inquiring about the possibility of receiving legal help. You are not a client or represented until you sign a Representation Agreement.

* Required

I have read the information above and I understand the privacy warning and agree to the terms of representation *

Title DR MISS MR MRS MS

First Name *

Last Name *

Email Address *

Day(s) Available * Monday    Tuesday    Wednesday    Thursday    Friday

Best Time to Call * 9-11am    11am-1pm    1-3pm    3-5pm

Date of Birth We need to know your date of birth for two reasons: identification purposes if you call or contact us again (many other people may have a name similar to yours) and to see if you qualify, based on your age, for any special programs that may give you additional help.**

What is your immigration status? Citizen    Resident Alien    Work Permit    Other

How many adults live in your household (include yourself)? *

How many children (under the age of 18 or in school) live in your household? *

What is your total monthly income from all sources? Look at your last pay stub. It is the total amount you are paid before taxes are taken out.*

If you have no income, please explain.  Tell us the source of that you live on.  If you receive public benefits, for example, Social Security, it is the amount of your Social Security check or the amount directly deposited into your bank account each month.

Do you speak English? * Yes    No

If no, what language do you speak?

What is the name and address of the person or entity causing your legal problem? *

Do you have a court hearing or government agency hearing? * Yes    No

If yes, when?

Where?

What court?

Are you in immediate danger of domestic violence? * Yes    No

My legal problem is (select the one that best applies) * Domestic Violence Family Problems not involving violence Debts/Financial Problems Government cash assistance or health care benefits have been denied Housing Other

If you selected "Other", please briefly describe:

Which one of the following counties or cities do you live in? * -- Please select -- Alexandria City Arlington Caroline Culpeper Essex Falls Church City Fairfax Fairfax City Fauquier Fredericksburg City King & Queen King George King William Lanaster Loudoun Madison Manassas City Manassas Park Northumberland Orange Prince William Rappahannock Richmond Spotsylvania Stafford Westmoreland

If you don't live in any of the above counties or cities, tell us where you live. *

What is your full legal name (first, middle and last name)? *

Tell us any other names you have used *

What is the best address we can use to send mail to you? *

What phone number should we use to call you?

Alternate phone (if different)

What county or city is your legal problem in? * -- Please select -- Alexandria City Arlington Caroline Culpeper Essex Falls Church City Fairfax Fairfax City Fauquier Fredericksburg City King & Queen King George King William Lanaster Loudoun Madison Manassas City Manassas Park Northumberland Orange Prince William Rappahannock Richmond Spotsylvania Stafford Westmoreland