MCC Legal Assistance Intake Form

Eligibility requirements:
187.5% of the federal poverty guidelines
Children living in your home between the ages of 0-17 years

Ethnicity(Required)
Marital Status(Required)
Are you a citizen of and eligible alien of the USA?(Required)
Gender(Required)
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Name:(Required)
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Address(Required)
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Do you have children between the ages of 0-17 currently living in your home?(Required)
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