LCC Intake

Intake Form Submission

Personal Information

First Name *

Last Name *

Phone Number *

Is this phone number safe for us to leave a voicemail on? * Yes No

Email*

What is your preferred method of contact? * Phone Email Text

Last Four of SSN

Address

City

State

Zip

Brief Description of Legal Problem *

Opposing Party Information

Name of Opposing Party

Alternative Names of Opposing Party

Phone Number of Opposing Party

Email of Opposing Party

Address of Opposing Party

Last Four of Opposing Party's SSN

Vets Information

Branch of Service*

Entrance into Active Duty*

Release from Active Duty*

Discharge Status*

OSU Information

Student ID Number*

Class Rank*

LCC Information

Student L-Number*

Appointment Details

Preferred Appointment Time

Inquiry Details

Have you ever used this office before? * Yes No

Legal Matter Type

Please select one area of inquiry. If you have multiple legal issues, please complete a submission for each issue:

Legal Service Type

Please select one area of inquiry. If you have multiple legal issues, please complete a submission for each issue:

Legal Service Type

Please select one area of inquiry. If you have multiple legal issues, please complete a submission for each issue:

Legal Service Type

Please select one area of inquiry. If you have multiple legal issues, please complete a submission for each issue:

SMS Opt In *

Yes No

Do you consent to receive text messages (SMS) from Access the Law regarding your consultation and related updates? Message and data rates may apply. You can reply "STOP" at any time to opt out. See our Privacy Policy for more info.