IL Advance Directive and Estate Planning Legal Clinic

IL Advance Directive and Estate Planning Legal Clinic
伊利诺伊州预先指示与遗产规划法律门诊

CASL will provide one-on-one legal consultations for income-eligible clients regarding Illinois advance directives and estate planning matters.

华咨处将为符合收入条件的客户提供一对一法律咨询，内容包括伊利诺伊州预先指示及遗产规划相关事项。

🕒 Please Select a Time Slot 请选择预约时间段

Please select an available time slot below. Each time slot can accommodate only two clients. Once a time slot is full, registration for that time slot will close automatically.

请在下方选择一个可预约的时间段。每个时间段最多可服务两位客户。时间段满额后，该时间段的注册将自动关闭。

⚠ Important Reminder 重要提醒

Please do not come to CASL unless you have successfully registered for a time slot.

除非您已成功预约时间段，否则请不要前往华咨处。

📍 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 may result in cancellation of your appointment.

请携带案件相关资料准时到场，迟到或缺席可能导致您的预约被取消。

ℹ Notice 敬告

This legal clinic provides consultation only. The program reserves the right to decline clients based on household income, case type, residence, or impolite behavior.

本法律门诊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

First Name 名字

Last Name 姓氏

Phone Number 手机号码

Email 电子邮箱 (选填)

Gender 性别

Preferred Language 您所使用的语言

Scheduling Information 预约信息

Legal Clinic Date 您注册的法律门诊日期如下

Please Select an Appointment Time 请选择预约时段

Pro Bono Clinic ID

Workshop Shift ID

Available Seats

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 of Adults 家庭成年人数量

Number of Minors 家庭未成年人数量

Monthly Employment Income 工作月收入

Number only, 仅填写数字

Monthly Public Assistance 公共福利月收入

Number only, 仅填写数字

Monthly Social Security/SSI 月入社会保障收入补助金、残疾补助金或养老金

Number only, 仅填写数字

Monthly Other Income 其他月收入（儿童抚养费/房东租金收入）

Number only, 仅填写数字

Other Income Explanation 其他月收入说明

Monthly Unemployment Compensation 失业金月收入

Number only, 仅填写数字

Monthly Special Expenses 月特别支出

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。

Special Expenses Explanation 月特别支出说明

Total Revenue

Monthly Income No Source Explanation 若无任何月收入，请在此详细说明

Confirmation 请确认

I confirm that all information I have provided in this form is true, accurate, and complete to the best of my knowledge at the time of submission. I understand that providing inaccurate or incomplete information may affect my eligibility for pro bono legal consultation services.

我确认，本人所填写的信息在提交时均为真实、准确且完整。我理解，若所提供的信息不准确或不完整，可能会影响本人获得公益法律咨询服务的资格。