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What is your marital status?

How many children do you have?

Do you own a home?

Yes
No

Do you have any other assets?

Yes
No

Are you employed?

Yes
No

What type of services are needed (check all that apply)?

Adoption
Child Custody
Child Support
Divorce
Domestic Violence
Spousal Support
Visitation Rights
Other

Please describe your situation:

Have you been served with any legal papers?

Yes
No

Is there currently a court hearing scheduled?

Yes
No

If you answer yes to either question, please indicate the date of service of papers and/or court hearing.

Have you reached any informal agreements with your spouse or partner?

Yes
No

What are these informal agreements?


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