Application for Assistance

Please select the phone number(s) we can leave voicemails on:
- Cell Phone
- Home Phone
- Work Phone

I am the:*
- Plaintiff
- Defendant
- Unsure/Not Applicable
Plaintiff: the person suing for a claim
Defendant: the person being sued for a claim
Please list all of the Plaintiff’(s) names relating to this matter: (full names of all individuals, company names and trade names)*
Please list all of the Defendant’(s) names relating to this matter: (full names of all individuals, company names and trade names)*
Please list any other persons or companies that might be involved in your matter:*

Do you have an upcoming court date?*
- Yes
- No
If you're unsure of have more details, add them by selecting "Other."

What is the nature of that appearance?*
- Motion
- Trial
- Mediation
- Pre-Trial Conference
Do you need to create court documents today?*
- Yes
- No
- Maybe

Do you need services in another language?*
- Yes
- No
Please note: PBLA does not provide interpretation/translation services, but you may arrange for an interpreter/translator to attend the appointment with you.
If yes, please provide the email address of the interpreter/translator who will attend the appointment with you.

Briefly tell us what your case is about. Please include names, dates and a brief description of your issue. Why are you seeking legal help today?*
What specific questions would you like to ask the lawyer?
1)*
2)
3)

Do you have any other cases pending in the Alberta justice system at this moment?*
- Yes
- No
- Unsure
2. Does the opposing party have a lawyer or representative?*
- Yes
- No
- Unsure
3. Do you currently have a lawyer or other representative currently helping you with this case?*
- Yes
- No
4. Has a lawyer ever assisted you with this case?*
- Yes
- No
If yes, why is that lawyer no longer assisting you?*
Is this your first meeting with a Duty Counsel lawyer through this program?*
- Yes
- No

I HEREBY REPRESENT THAT THE information that I have provided is true and accurate to the best of my knowledge and belief.

Print name:*
This must be your legal name as it appears on legal documents and identification.

Personal Information