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Indiana University Bloomington

Student Student Legal Services

Schedule Schedule Appointment

Intake Form

Please fill out completely and click the submit button at the bottom of the page.

Name:

Student ID Number:

Local Address

Street:     Apt.#:

City:    State:      Zip:

Home Phone*:        Work Phone:

Cell Phone:    

Email address*:

Permanent Address

Street:      Apt.#:

City:       State:      Zip:

Phone:         Cell Phone:

Email address:

Adverse Party

This is the person(s) you're having a problem with. Not all situations will have an adverse party.

Name*:

Street:       Apt.#:

City:     State:     Zip:

Phone:         Cell Phone:

Email address:

Is adverse party an IU student? Yes No

Additional Parties

List any other people involved in your situation. Check whether or not they are an adverse party.

Name:

Street:      Apt.#:

City:       State:       Zip:

Phone:         Cell Phone:

Email address:

Is this an adverse party? Yes No

Is this an IU student? Yes No


Name:

Street:      Apt.#:

City:     State:     Zip:

Phone:         Cell Phone:

Email address:

Is this an adverse party? Yes No

Is this an IU student? Yes No

Important Information: Please Read

Student Legal Services has two missions: service to students and training for law students. Except for a few circumstances, you will be interviewed by a law student intern who is supervised by a licensed attorney. Please indicate that you have read and understand this statement.

Yes, I understand.

MAY WE VIDEOTAPE YOUR INTERVIEW?
By permitting us to tape your interview, your legal intern and supervising attorney will be able to better analyze your situation. The tape will also be used to critique the intern's interviewing skills.

The tape will be protected by the attorney/client privilege and will not be seen by anyone who is not a member of our staff. Please check the appropriate statement:

Yes, I have read the above waiver and consent to having my interview taped.

No, I do not wish to have my interview taped.

How did you learn of our services? (check all that apply)

Faculty/Administrator
Friend
Former Client
Facebook
IDS
Advertising: If so, where?
Orientation
Other

Fact Sheet

In this box, please describe your situation in narrative form. Please remember that the more detailed you are now, the quicker we will be able to help you.