Lakeshore: Pro Bono Expungement Clinic Intake Form

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To register for a clinic with Lakeshore’s Pro Bono Program please complete this online form. This may take you 5 to 10 minutes.

To apply online:

You will need a phone number or email address where we can safely reach you,
You must live in Michigan or have a legal problem in Michigan, and
You must be able to name the "opposing party." This is the person or "party" you are having the legal problem with. For example: Michigan DHHS, your landlord, a debt collector, your spouse. In a few cases, like if you want a will or Power of Attorney, you don't have to name an opposing party.

If you can’t use our online system, you can call by phone at 1-888-783-8190. You can call Monday through Thursday between 9:00am - 5:00pm (and until 6:00 on Wednesday only), or Friday between 9:00am - 1:00pm. You can apply online at any time.

All your answers are private and will not be shared with anyone other than our Lakeshore Legal Aid staff and the pro bono attorney you will be meeting/talking with at the clinic.

After you submit your application, we will review it. If you meet the requirements for our clinic, we will email you with a confirmation that will include a time and place for the clinic within three business days of when you submit your application.

We care about your safety and privacy.

This is a secure website. But if you are using a public or shared computer, close the Internet browser when you are done. If you don’t, you might accidentally share your personal information with someone else.

If you fear for your safety where you are now, please do not use our online application. Please call us instead at 888-783-8190, Monday through Thursday between 9:00am - 5:00pm (and until 6:00 on Wednesday only), or Friday between 9:00am - 1:00pm.

Please let us know that you understand these concerns and want to continue.

I understand and want to continue.

YesNo

This is an application for legal help. We do our best to help everyone in Michigan who has a low income, but we may not be able to take your case because there are more people who need our services than we can help. Filling out this application does not guarantee you will get a lawyer. Do you understand that completing this application does not guarantee that you will get help, and does not create an attorney-client relationship with Lakeshore Legal Aid or any partner programs for the clinics?

YesNo

Agreed to continue

We're now going to ask you some questions to see if we can help you. We'll need to know information about you and the people in your household. Answer the questions as best as you can.

When you are finished with each page, click "next page." If you make a mistake and need to go back, click "previous page." Do not use the back button in your browser. At the end, click "submit" and we will review your application.

Declined to continue

If you are concerned about either your privacy or your safety, and have decided not to use our online intake application, Please call us instead at 888-783-8910. If you changed your mind or made a mistake, please choose “yes” above to continue.

We’re sorry. You cannot continue unless you understand and agree to the terms of use.

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Self Completion

Are you completing this intake for yourself?

Yes
No

Non Self Completion

The person requesting assistance should complete this form. If the person is unable to complete the form without assistance, please contact Lakeshore Legal Aid's Pro Bono Department at 313-242-0811 x 1310 or email us at probono@lakeshorelegalaid.org

Military Service

Does any other member of your household serve in the military now or did they serve in the past?

Yes
No

Non Veteran

This is a Veteran Clinic. Preference of registration is being given to Veterans, thus, we are unable to register you at this time. If you are trying to register for assistance please check Michigan Legal Help for other Expungement events. If you are not a Veteran you maybe able to attend the Clinic on May 19th if spots remain available after preference is given to Veterans. You may check back on May 3, 2023 to see if registration has opened for Non-Veterans.

https://michiganlegalhelp.org/legal-clinics-and-events

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Are you a U.S. citizen or LPR (green card holder)?

U.S. CitizenLPR (green card holder)I am not a U.S. citizen or a LPR (green card holder)

Hidden section

Is domestic violence a factor - from triage

YesNo

Problem code - from triage

County - from triage

Veteran or Service Member - from triage

YesNo

Client Information

Name

First Name

Last Name

Middle Name

Suffix

Email

Email address

Is it safe to email you?

YesNo

Please Select the options that most clearly reflect your identity

Pronouns

LGBTQIA+ Status

Gender

Ethnicity

Other Information

Date of birth

Marital Status

Pick the one that best describes your marital status

If you are NOT a U.S. Citizen or LPR, please call us at 1-888-783-8190 so we can find out if we are able to help you. If you need to talk to someone in a language other than English, leave a message with your language and phone number.

If you are being evicted and need help, you can also use MLH's Eviction Resource page and call the HARA in your county for rental assistance. For legal help with eviction, if you are in Wayne County, call Michigan Legal Services at 313-964-4130; all others, please check back soon for additional information.

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Mailing Address

My mailing address is a post office box

Street

City

State

Zip Code

County

Is it safe to send you mail to this address?

Yes
No

Physical and Mailing Address the same?

YesNo

Physical Address, if different from Mailing Address

Street

City

State

Zip Code

County

What best describes where you are living?

If a residence is a mobile home, what is rented

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Best time to contact you

We'll be calling you to talk more about your legal problem. When is it best for us to call you?

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Adults

How many adults live in your household?

Count people 18 and over including yourself. If you need help getting separated from someone who lives with you, don’t count that person.

Children

How many children live in your household?

Count people under 18 including yourself if you are under 18.

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Disability

Do you have a disability?

Yes
No

Describe Disability

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You must qualify for our services to get help. For this question, we need information about income for every person in your household, except for someone who is the opposing party (such as someone you’re separating from or divorcing). Please include everything: income from work, child support you receive, and benefits like unemployment, Social Security, or cash assistance (FIP). Do not include Food Stamps (FAP) here. Pick an income type to submit information about every kind of income that is brought into your household (except for the opposing party’s income).

Your primary income

Income Type

Describe other

Frequency: when are you paid?

Amount

$

Income From Other Household Members

Income Type

Describe other

Frequency: when are you paid?

Amount

$

Do you or your household have any additional income? *

Yes

No

Remember to include income from every person in your household except for the opposing party

Additional Income

Income Type

Describe other

Frequency: when are you paid?

Amount

$

Food Stamps

Do you receive food stamps?

YesNo

Amount of food stamps received

Do you expect your household income to change in the near future?

No, my/our income is NOT likely to change in the near futureYes, my/our income is likely to go UP in the near futureYes, my/our income is likely to go DOWN in the near future

Prospects for increased or decreased income

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Household Assets

Another part of eligibility is asking about your household's assets - money and property you own. For each kind of asset your household has, enter the dollar value for those assets. If you do not have that type of asset, enter a zero. Don’t count assets that only belong to a household member who is an opposing party. If you and the opposing party both have access to an asset, count it here.

Checking/ Savings Amount

$

Investments

Stocks/Bonds/IRAs/Trusts

Investments - Amount

$

Personal Property

Total value of household property BEYOND normal household furniture and work equipment.

Personal property: total value of household property beyond normal household furniture and work equipment

$

Real Estate

any real estate owned aside from your primary residence

Value of Real estate owned aside from your primary residence

$

Other Assets - if other amount is listed a brief description is required in the box below

Other Assets - Amount

$

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We know a little bit about your problem already. Please briefly explain how you want to resolve your problem. (600 characters max)

For example, if you are being evicted: “I want to stay in my home.” OR “I want to move, but I need more time.” If your case involves DHHS: “I want to get my food stamps back.” Or, in a family matter: “I want to get a divorce. And I will need child support.”

Other Legal Problem (600 characters max)

If you have any other legal problems, please quickly mention them here. We will ask you about it when when we talk to you. Do not submit another application.

By clicking "submit" you send your application to Legal Services. You should hear something via email, text, and/or phone within 3 business days to let you know if we can help you.

You do not need to call us, but if you do, please tell us about your online application when we talk. Thank you!