CASL Pro Bono Legal & Behavioral Health Clinic Registration Form

华咨处公益法律援助及行为健康咨询注册表

Location 地点
2141 S Tan Court, Chicago, IL 60616
Chinese American Service League, 2nd Floor – Harmony Hall
华人咨询服务处，2楼 – 敬乐大堂
Arrival Reminder 到场提醒
Please arrive on time and bring all relevant documents. Tardiness or absence will result in cancellation of your appointment.
请携带案件相关资料准时到场，逾时不候。
Privacy Notice 隐私说明
When you submit this form, it will not automatically collect your personal details such as your name or email address unless you provide them yourself.
Notice 敬告
The Pro Bono Legal Clinic provides legal consultation only. The program reserves the right to decline clients based on household income, case type, residence, or impolite behavior.
本公益法律诊所仅提供法律咨询服务；本项目保留基于家庭收入、案件类型、居住地或当事人态度不恭等因素，拒绝提供服务的权利。
Personal Information 个人信息






Scheduling Information 预约信息








*Legal Pro Bono Clinic doesn't handle criminal defense, personal injury, or malpractice cases.
华咨处公益法律援助服务不接收刑事辩护、人身伤害或医疗事故案件

Household Income Disclosure Statement 家庭收入信息声明

Why We Ask About Household Income and Household Size

To determine whether you are eligible for pro bono (free) legal consultation, we are required to collect information about your household income and household size, including the number of adults and minors in your household.

We understand that this information is personal and sensitive. Please know that your responses will be kept confidential and used solely to assess eligibility for our pro bono legal services, in accordance with program requirements and applicable privacy policies.

Providing accurate information helps us ensure that our limited legal resources are directed to individuals and families who qualify for and most need these services.

我们为何需要询问家庭收入与家庭成员人数


为确认您是否符合公益（免费）法律咨询服务的资格，我们需要收集您的家庭收入情况以及家庭成员人数，包括家庭中的成年人及未成年人数量。


我们理解这些信息具有一定的个人敏感性。请您放心，您所提供的所有信息将被严格保密，并仅用于评估您是否符合公益法律服务的资格，相关使用将遵循项目要求及适用的隐私保护政策。


您所提供的准确信息，将有助于我们将有限的法律资源合理分配给最符合条件、且最需要帮助的个人与家庭。

Household Information 家庭信息



Number only, 仅填写数字

Number only, 仅填写数字

Number only, 仅填写数字

Number only, 仅填写数字


Number only, 仅填写数字

Monthly special expenses are ongoing and unavoidable costs that place a financial burden on your household, such as medical expenses, disability or special care, childcare or dependent care, court-ordered payments, or transportation for medical or work-related reasons. “每月特殊支出”是指每月持续发生、无法避免、并对家庭经济造成负担的费用，例如医疗费用、残障或特殊照护支出、子女或受抚养人照护费用、法院判决的相关支出，或因医疗或工作需要产生的交通费用。



Confirmation 请确认