Application for Services
Legal Services of North Dakota
State Bar Association of North Dakota - Volunteer Lawyer Program & Reduced Fee Program

Please fill out the application completely and push the submit button when you are finished. You will receive an e-mail confirmation that your application has been submitted after the submit button is pushed. You will receive a response via phone, letter or e-mail within seven (7) working days. Please remember to check your e-mail.  You will only receive 20 minutes to complete this application. If it will take longer than 20 minutes to complete the application including the description, you may want to type your description in Notepad or Wordpad first, then complete the application and paste the notes into the description before you submit.

Legal Services of North Dakota does not discriminate on the basis of race, color, national origin, religion, sex, disability, or age in the delivery of services.

 

Required Information * Application will not submit without information
Please provide your legal name and address where you can receive mail.
First Name* Last Name*
Spouse's First Name (Optional) Spouse's Last Name (Optional)
Address* City*
State* Zip Code*
Please provide a telephone number where Legal Services staff can best reach you between 9:00 a.m. and 4:30 p.m. central time, Monday through Friday.

                               Area Code Phone Number

Please provide your citizenship status below:
Are you a
US Citizen? *
Type of Citizenship *
Please complete the following information to help us determine your eligibility for our program.
Marital Status* Where do you live?*
Birthdate* mm/dd/yyyy
E-mail address*
Race (Optional) Sex*
Are you a victim of crime?
Victim of crime?
Have you or any member of your household ever been in the military?
Veteran in Household?*
Please include all people that live in your household. Include yourself, children, parent, grandparent, spouse, significant other or any other person living in the household.
Number of children * Number of adults* Include yourself
How did you learn about
Legal Services*  
Social Security #: (Optional)
What is the name of the person, agency, or business you are having a problem with? If you are having problems with a business or agency, insert the word business in the first name area and the name of the business or agency in the last name area.
First name of person* (25 Character Max) Last name of person, agency, or business* (25 Character Max)

A short description of the problem you are having. Please provide enough information that will help us understand your problem and what kind of help you are looking for.


Please enter INCOME information for EACH person in the household, including yourself, child, parent, grandparent, spouse, significant other or any other person living in the household. Please also include in prospective income sources.
Household Member* Income Source **MONTHLY GROSS INCOME **


NUMBERS ONLY!!
Monthly Gross Income
Monthly Gross Income
Monthly Gross Income
Monthly Gross Income
Other: Monthly Gross Income

Please enter ASSET information for EACH person in the household, including yourself, child, parent, grandparent, spouse, significant other or any other person living in the household. Click the Help button for further explanation.
    NUMBERS ONLY  
Household Member * Asset Source Amount  
Other:
       
When you push the Submit Application button you are saying that all of the information provided is true and complete and the Submit Application button is considered the same as your signature per 15 U.S.C. §§7000-7006 and the Uniform Electronic Transactions Act (UETA).