Metro West Legal Eligibility Form
Are you 60 or older?
Yes
No
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Where are you located?
Please Select
Acton
Ashland
Bedford
Bellingham
Carlisle
Concord
Dedham
Dover
Foxborough
Framingham
Franklin
Holliston
Hopkinton
Hudson
Lexington
Lincoln
Marlborough
Maynard
Medfield
Medway
Millis
Natick
Needham
Norfolk
Norwood
Plainville
Sharon
Sherborn
Stow
Sudbury
Walpole
Wayland
Wellesley
Weston
Westwood
Wrentham
Not Listed
Where are you located?
Please Select
Acton
Ashland
Belmont
Brookline
Canton
Dedham
Dover
Foxborough
Framingham
Holliston
Hopkinton
Hudson
Marlborough
Maynard
Medfield
Millis
Natick
Needham
Newton
Norfolk
Northborough
Norwood
Plainville
Sharon
Sherborn
Southborough
Stow
Sudbury
Walpole
Waltham
Watertown
Wayland
Wellesley
Westborough
Weston
Westwood
Wrentham
Not Listed
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Are you the person requesting services or are you requesting for someone else?
I am the person requesting services
I am requesting services for someone else
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Do you require interpretation services? If so, what language?
No, I do not require interpretation services
Spanish
Portuguese
Other
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Are you a victim of crime?
Yes
No
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How many people are in your household?
Please Select
1
2
3
4
5
6
7
8
What is your annual household income?
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Based on your responses you are within our service area and may be eligible for services. Please fill out the form below to contact us.
Name
*
Preferred Pro Nouns
Legal First Name
Preferred First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Are you homeless?
Yes
No
Safe Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Safe Phone Number
*
Please enter a valid phone number.
Alternative Phone Number
Please enter a valid phone number.
Any special instructions concerning contacting the applicant
Which category does your legal problem fall into? Check all that apply. Note: MWLS does not handle criminal cases.
Housing
Immigration
Special Education Services
Government Benefits
Elder Law
Family Law
Domestic Violence
Victim of Crime
Other (please describe below)
Briefly describe your legal problem
0/300
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Thank you
Thanks for taking the time to fill out this form. You do not appear to be eligible to receive our services, but we may be able to refer you to other agencies or resources that can provide legal assistance. Please feel free to call our office at 508-620-1830 for more information.
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