NOTICE: Required fields marked with an asterisk (*) MUST be completed in order to process the application. The information obtained on this form will be used to help determine if we can assist you with your legal needs. The information you provide is confidential but it must be completed and truthful. If you are accepted as a client, and if it is later determined that the information you have provided on this form is incomplete or untrue, the Hendricks County Pro Bono Program or your assigned attorney may terminate the attorney/client relationship.

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    This is the old form capture field, currently "hidden" to retain previous associated data in the database. DO NOT USE THIS FIELD.

By clicking SUBMIT, I certify and affirm that I have read the above or had it read to me; I fully understand the information contained herein, and it is true and correct to the best of my knowledge. I request that this information be considered in determining my eligibility to receive free legal services from the Hendricks County Pro Bono Program. I hereby authorize the Hendricks County Pro Bono Program to release records and information pertaining to my case to the pro bono attorney(s).