Are you getting ready to file for Divorce in Snohomish County? *
Are you getting ready to finalize a Divorce in Snohomish County? *
Has there been Domestic Violence between you and the Opposing Party? *
At this time, do you feel safe in your primary place of residence? Are you afraid or feel in danger from your partner/spouse/significant other/roommate/family member who live with you?
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How have you been affected by COVID-19? (check all that apply) *
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Will you be willing and able to meet with an attorney with videoconference (Zoom or GoogleMeet)? *
How did you hear about us? Who referred you to our services? *
Your answer
Birthdate *
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Age *
Your answer
Do you reside in Snohomish County? *
Street Address (where you actually live) *
Your answer
City, State *
Your answer
Zip Code *
Your answer
Living Situation? *
Does your legal matter affect the stability of your housing situation? *
Preferred Phone number *
Your answer
Home Phone number
Your answer
Mobile Phone number *
Your answer
Can we leave Voicemails at this number? *
Are you willing to receive texts? *
Email Address *
Your answer
What is your primary language? *
Do you require or would you like to request an interpreter? *
Client Ethnicity *
Client Race *
Gender *
Highest Level of Education? *
Health Insurance Status? *
Are you a Veteran? *
Do you identify as someone living with a disability? *
Citizenship status? *
Family Type: Family living with you that you are financially responsible for. (If you are currently living with your spouse and trying to separate, please select 'other' and explain) *
Family Size: How many Adults live with you that are in a personal relationship with you (i.e. domestic partner - do not list roommates) *
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5
Please list the full name and date of birth of the other adults who are part of your financial household, along with their date of birth and your relationship with them. (ex. Jane Doe, 01/01/2001, sibling). *
Your answer
Family Size: How many children do you have that are still financially dependent on you? *
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Children's Ages *
Your answer
How many of your own children live primarily with you? *
What is your GROSS monthly income? (Income before taxes are taken out) (INCLUDE THE INCOME OF ANY DOMESTIC PARTNERS THAT RESIDE WITH YOU) *
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What is the source of that income? (CHECK ALL THAT APPLY) *
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Please enter the gross amount of EACH source of income, including food assistance. *
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