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Application for Assistance
Personal Information
Where are you located?
*
Calgary
Edmonton
Other
Mention the name of other location:
*
First Name:
*
Last Name:
*
Date of Birth (dd/mm/yyyy):
*
Address:
*
Email Address:
*
Cell Phone:
*
Home Phone:
Work Phone:
Please select the phone number(s) we can leave voicemails on:
Cell Phone
Home Phone
Work Phone
What type of program/ service do you require?
*
Civil Claims Duty Counsel
Queen’s Bench Amicus Court
For more information click here
Civil Claims Duty Counsel
Queen's Bench Amicus Court
How do you wish to receive assistance?
*
Telephone
Videoconference
Case Information
I am the:
*
Plaintiff
Defendant
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? If so, when?
Date
Time
:
HH
MM
AM
PM
What is the nature of that appearance?
Motion
Trial
Mediation
Pre-Trial Conference
Other
Not Applicable
Do you need to create court documents today?
*
Yes
No
Maybe
Do you need services in another language?
*
Yes
No
If yes, please provide the email address of the interpreter/translator who will attend the appointment with you.
Additional Information
Briefly tell us what your case is about. Why are you suing or being sued?
*
What specific questions would you like to ask the lawyer?
1)
*
2)
3)
1. Do you have any other cases pending at this moment?
*
Yes
No
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:
*
Date (dd/mm/yyyy):
*
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