If you or someone that you know needs Legal Aid or Assistance, PLEASE copy and paste the completed form in the comments section below so that we can determine the best way to assist them.
This form is provided with the understanding that A&MWF is not rendering legal, accounting, or other professional advice or service. Professional advice on specific issues should be sought from an accountant, lawyer, or other professional.
LEGAL AID INTAKE REFERRAL FORM
Please note that this information has been gathered to help us provide Your Client with a service that will meet thier needs. The information will be treated in STRICT CONFIDENCE.
How can we help you
Best Contact Information For Applicant(required)
Current Address of Applicant
Phone Number
Age
Date of Birth
Sex
Married, Family. List your dependants, include spouse/defacto/partner/children
Given Name of Applicant
Family Name of Applicant
Does Applicant Use or Has Used Other Names? Please give other name(s)
Is The Aid For A Business, Corporation, Group or Organization
For What Type of Problem Do You Need Legal Aid/Assistance? Family, Criminal, Civil, General
Is The Applicant/Client in Custody or Detention?
What Is The Applicant/Client’s Prisoner Identification Number
When Is The Next Court Date (if you know)?
Have You Applied for Legal Aid/Assistance Before?
Is This Application Being Made for Someone Else?
Name of Referring Person
Contact Information of Referring Person
Why have You Refered Your Client for Legal Aid/Assistance
Where is Your Client Currently Residing
How long Have They Resided There
Are They Moving Out, Why?
Has Your Client Been Registered with Local Social Services, Medical, Housing Authorities? Which Ones?
Do You Speak a Language Other than English at Home?
Were You Born Overseas?
Are You A United States Citizen?
HEALTH HISTORY
Your Client’s Doctor’s Contact Information
Are you aware of any serious physical health problem your client may currently be suffering from or have suffered from in the past? If yes please elaborate.
Has Your Client Ever Suffered from Any Psychiatric illness? If yes please elaborate.
Is Your Client Living with Any Psychiatric illness at present? If yes, please elaborate.
Is Your Client in Contact with Any Support Agency Concerned with Psychiatric illness or with Any Psychiatric Unit? If yes, please give details.
Is Your Client on Any Type of Medication? If yes, please give details.
Does Your Client have Any Learning Difficulties? If yes, please elaborate.
Have these difficulties been formally identified through the health board disability services? If Yes please elaborate
PATTERNS OF BEHAVIOUR
Has Your Client Ever Been the Victim of Violence? If yes, please elaborate.
Has Your Client Ever Had an Addiction Problem? If yes, what form(s) has this taken?
Is Your Client Currently Drinking, Using Unprescribed Drugs, or Gambling? If yes, please elaborate.
Has Your Client had Contact with Any Addiction Support Service? If yes, please elaborate.
Has Your Client Had a Criminal Conviction? If yes, please elaborate.
Has Your Client Had Any Involvement with the Probation Service? If yes, please elaborate.
Has Your Client Ever Attempted to Inflict Serious Self Harm? If yes, please elaborate.
Does Your Client Have Any Behavioural Problems? If yes, please elaborate.
Is Your Client Receiving Any Support / Assistance from Any Services for These Problems? If yes, please elaborate.
CLIENT’S FINANCIAL SITUATION
What is Your Cient’s Main Source of Subsistence? Employment, Unemployment Assistance/Benefit, Sickness Benefit, Disability Allowance, Pension, Job Training Allowance, Grant, Other
If Your Client is On a Pension or Grant or Another Source of Subsistence, please state It’s Source, the Amount, Method and When It’s Paid.
What is The Main Source of Income of Anyone Financially Associated with Your Cient. Do they Receive Employment, Unemployment Assistance/Benefit, Sickness Benefit, Disability Allowance, Pension, Job Training Allowance, Grant, Other
Does Your Client, Anyone Financially Associated with Your Cient or Any Dependant Children Receive Employment, Unemployment Assistance/Benefit, Sickness Benefit, Disability Allowance, Pension, Job Training Allowance, Grant, A Partner in a Business, A Director/Shareholder in a Business or Company, Receiving Money From a Trust, Receiving Any benefit from a Business or Company? For example, use of a Car, Telephone, Payment of School Fees, Other
Does Your Client, Anyone Financially Associated with Your Cient, or Any Dependant Children make Housing Payments, Mortage, Rent, Board on Your Client’s Behalf and How Much?
Does Your Client, Anyone Financially Associated with Your Cient, or Any Dependant Children Pay Any of the Following Expenses Each Week on Your Client’s Behalf? Child Care , Spousal Support, Loans, Other debts.Give details
Does Your Client, Anyone Financially Associated with Your Cient, or Any Dependant Children Own a Home or Any Other Real Estate? Give financial details
Does Your Client, Anyone Financially Associated with Your Cient, or Any Dependant Children Own Any Motor Vehicles, Including Vehicles You are Paying Off and Other Person’s Vehicles. Give details of Your Vehicles Year , Model, Market Value, Money Owing.
Does Your Client, Anyone Financially Associated with Your Cient, or Any Dependant Children have any Financial Accounts with a Bank, Financial Instution, Credit Union, have Financial Instruments, Cash or Money Invested with Other Persons? Give Details of Accounts
Does Your Client, Anyone Financially Associated with Your Cient, or Any Dependant Children Own Anything Else of Value? For example, Shares of Stock, Bonds, Boats, Precious Metals, Jewellery, Insurance, Etc.? Give Details of Accounts
Has Your Client, Anyone Financially Associated with Your Cient, or Any Dependant Children Sold or Given Away any Money or Property Worth More Than $500? Give Details.
Did Your Client, Anyone Financially Associated with Your Cient, or Any Dependant Children Get Any Lump Sum Amount(s) of Money Greater than $500 in The Last 12 months? For example, a Loan, Gift, Compensation, Award from a Court Case, etc.? Give Details.
Does Your Client, Anyone Financially Associated with Your Cient, or Any Dependant Children Expected to Get Any Lump Sum Amount(s) of Money in the next 12 months? Like a loan, gift, Compensation, Award from a Court Case, etc.? Give Details.
Has Your Client, Anyone Financially Associated with Your Cient, or Any Dependant Children Paid Any of Your Legal Fees for This Case? Can/ Will They Pay Any Fees? Give Details.
Briefly Explain Your Legal Problem— Please Attach Copies of Any Documents, Summonses or Charge Sheets Relating to This Matter. Do Not Give Originals and Provide Details.
For Criminal Matters—What Offences are Your Client Charged With? Give Details.
For All Other Matters— Give Details.
What and Where is the Court and Provide Case Number, Judge?— Give Details.
Has Your Client Had an Attorney In This Case? Who Do They Want as Their Lawyer? In Some Cases, You May Not Get the lawyer you Choose. Want A Legal Aid lawyer, A Private Lawyer?— Give Details.
FAMILY LAW ONLY
Provide Details of The Person(s) Your Client Is In Dispute With. Their Full Name, Date of Birth, Address, Phone Number, Their lawyer’s Name, Lawyer’s Address
Was Your Client Married to The Person They are in Dispute With? Give Date of Marriage, Date of Separation, Date of divorce
Has Your Client Been to Counselling/Mediation? Give Details
Is There Existing Court Orders in Relation to This Dispute? Give Details
CRIMINAL LAW ONLY
Was Anyone Else Charged with Your Client for These Offences? Give Details
Is Your Client Committed for Trial? Give Details
Does Your Client Have Any Prior Convictions? Give Details
CIVIL OR GENERAL LAW ONLY
Please Give The Date and Place where Your Clients Accident or Problem Happened.
Who is Your Client in Dispute With? Please Give Details if Known
Is Your Client Insured Against Any Part of This Claim/Loss? Give Policy Information, Name and Address of Insurer
What Is Your Client ‘s Estimate The Amount of The Claim/Loss
OTHER INFORMATION
Is There Any Other Information That You Would Like to Offer?
Give Us Your Self Assessment of The Situation
Please note that this information has been gathered to help us provide Your Client with a service that will meet thier needs. They should not fail to provide information required of them and which is relevant to this application for legal aid/assistance. They MUST provide all documents to us in connection with this application for legal aid/assistance and it is a crime to present information that is false or misleading and they MUST NOT make a false or misleading statement either orally or in writing in relation to this application for legal aid/assistance and therefore declare that all the information they have given is true and correct. The information will be treated in STRICT CONFIDENCE.
I Accept the Aaron and Margaret Wallace Foundation’s Terms of Submission.
Legal Information & Assistance
Drop-in legal information for tenants twice a month at OHA.
Click here to view the schedule
Bay Area Legal Aid
405 14th Street, 11th floor
Oakland, CA 94612
(510) 663-4744
(800) 551-5554
Centro Legal de la Raza
1001 Fruitvale Avenue, Second Floor
Oakland, CA 94601
Spanish – (510) 437-1554
English – (510) 437-1554 and press 2 #
East Bay Community Law Center
3130 Shattuck Avenue
Berkeley, CA 94705
(510) 548-4040
Eviction Defense Center
1611 Telegraph Ave
Oakland, CA 94612
(510) 452-4541
National Housing Law Project
614 Grand Ave., Ste. 320
Oakland, CA 94610
(510) 251-9400
Oakland Rent Arbitration Board
250 Frank H. Ogawa Plaza, 5th Floor
Oakland, CA 94612
(510) 238-3721
http://www.oaklandnet.com/government/hcd/rentboard/index.html
Sentinel Fair Housing
510 16th Street, Ste. 560
Oakland, CA 94612
(510) 836-2687
Additional Legal Resources
Alameda County Bar Association
610 16th Street, Ste. 426
Oakland, CA 94612
(510) 893-7160
Law Center for Families
510 16th Street, Suite 300
Oakland, CA 94612
(510) 451-9261
Lawyers in the Library
Oakland Public Library
(510) 239-3134
http://www.oaklandlibrary.org/services/lawyers.html
Legal Assistance for Seniors
464 7th Street
Oakland, CA 94607
(510) 832-3040
Small Claims Legal Advice Program
661 Washington Street, 2nd Floor (Self Help Center)
Oakland, CA 94607
(510) 268-7665
Mediation
Trained mediators help landlords and tenants resolve disputes by helping both parties talk through the problem and come to an agreement together.
East Bay Community Mediation
1968 San Pablo Ave
Berkeley, CA 94702
(510) 548-2377
Sentinel Fair Housing
510 16th St., Ste 560
Oakland CA 94612
(510) 836-2687
Fair Housing & Discrimination
Bay Area Legal Aid
405 14th Street, 11th floor
Oakland, CA 94612
(510) 663-4744
(800) 551-5554
Housing Rights
P.O. Box 12895
Berkeley 94712
(510) 548-8776
Sentinel Fair Housing
510 16th Street, Ste. 560
Oakland, CA 94612
(510) 836-2687
U.S. Department of Housing & Urban Development (HUD)
Office of Fair Housing and Equal Opportunity
450 Golden Gate Avenue
San Francisco, CA 94102-3448
(415) 436-8400
(800) 347-3739
TTY (415) 436-6594
Fair Housing Information
http://www.hud.gov/offices/fheo/
Housing Discrimination Complaint Line: (800) 669-9777
Disability Resources
AC Transit Paratransit
(510) 817-1717
http://www.actransit.org/riderinfo/paratransit.wu
Access Improvement Program
City of Oakland grants for accessibility modifications in rental housing
Residential Lending & Rehabilitation Services
(510) 238-3909
www.oaklandnet.com/government/hcd/loansgrants/access_rent.html
Center for Independent Living (CIL)
2539 Telegraph Ave
Berkeley, CA 94704
(510) 841-4776
TDD: (510) 848-3101
CIL Field Offices:
Oakland Office
610 16th Street, 4th Floor
Oakland, CA 94612
(510) 763-9999
TDD: (510) 444-1837
Fruitvale Satellite Office:
Centro de Vida Independiente CIV
Spanish Speaking Citizens Foundation
1470 Fruitvale Avenue
Oakland, CA 94601
(510) 536-2271
East Oakland Office:
7200 Bancroft Ave, Suite 9 A
Oakland, California
(510) 635-4920
Disability Rights Education & Defense Fund
2212 Sixth Street
Berkeley, CA 94710
(510) 644-2555 V/TTY
Housing Consortium of the East Bay
(for people with developmental disabilities)
1736 Franklin Street, 6th Floor
Oakland, CA 94612
(510) 832-1315
Housing Rights
P.O. Box 12895
Berkeley 94712
(510) 548-8776
Protection & Advocacy Incorporated
433 Hegenberger Road, Suite 220
Oakland, CA 94621
(800) 776-5746 Voice/TDD/TTY
U.S. Department of Veterans Affairs
Online government disability resources:
Federal disability resource page:
Americans with Disabilities (ADA) Homepage
http://www.usdoj.gov/crt/ada/adahom1.htm
Senior Resources
Adult Day Services Network of Alameda County
7751 Edgewater Drive
Oakland, CA 94601
(510) 883-0874
AC Transit Paratransit
(510) 817-1717
http://www.actransit.org/riderinfo/paratransit.wu
Alameda County Adult & Aging Services
Eastmont Town Center
6955 Foothill Blvd, Suite 300
Oakland, Ca 94606
(510) 577-1900
http://www.alamedasocialservices.org/public/about/departments/
Bay Area Community Services
Post Office Box 2269
Oakland, CA 94621-2269
(510) 613-0330
TDD: (510) 613-0328
Family Bridges, Inc.
168 11th Street
Oakland, CA 94607
(510) 839-2022
Legal Assistance for Seniors
464 – 7th Street
Oakland, CA 94607
(510) 832-3040
Over 60 Health Center/ LifeLong Medical Care
2031 Sixth Street
Berkeley, CA 94710
(510) 704-6010
St. Mary’s Center
635 – 22nd Street
Oakland, CA 94612
(510) 893-4723
The Unity Council
1900 Fruitvale Ave., Suite 2A
Oakland, CA 94601
(510) 535-6900
(510) 534-7771
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