Contact ID
Program Engagement ID
Legal Clinic ~
REGISTRATION
September 30, 2026
4pm - 6pm
APS Student and Family Support Hub
601 Thomas Cole Jr. Way SW
Attendance
If you are interested in this service but are unable to attend this event, please check here and someone from AVLF will reach out to you.
First Name
Last Name
Your Birthdate
Email
Phone Number
Can AVLF contact you via text message at this number
Yes
No
Your Home Address
Street Address
City
State
Zip Code
Sometimes tenants have problems with previous landlords/apartments/etc. Is your home address the same address where you are experiencing a problem?
Yes, I live at the address where I'm having problems.
No, my home address is different from the address where I am experiencing problems.
Other Address
Street Address
City
State
Zip Code
Issue(s): Select all that apply
Eviction
Housing Conditions
Other Landlord/Tenant Issue
Intimate Partner Abuse
Other
Eviction Details
Eviction Status
I've already been served an eviction notice from the court
I have not been served by the court, but I am at risk of eviction
If you know your case number, enter it here. If you do not know your case number, please leave BLANK.
Explain your issue(s) briefly and let us know if there are any upcoming court dates.
Name of adverse party (name of housing complex, landlord, or other person if a family/partner issue)
Demographic Information
Gender Identity
Male
Female
Non-Binary
Transgender
Prefer not to say
Prefer to self-describe
Pronouns
He/him/his
She/her/hers
They/them/theirs
Use name
Not listed/please ask
Prefer not to say
Race/Ethnicity
Please select...
Black or African-American
White
Hispanic/Latinx
Asian/Pacific Islander
Middle Eastern or North African
Multiracial
Native American
Other
Prefer not to say
Military Service
Active military
Veteran
None
Insurance Provider
Uninsured
CareSource
Kaiser Permanente
Amerigroup/Anthem
Centene/PeachState
WellCare
Other
Do you have a disability?
Yes
No
Prefer not to answer
Type of disability?
Vision impaired
Hearing impaired
Limited mobility/Physical disability
Cognitive disability
Other
Does any other member of your household have a disability?
Yes
No
Prefer not to say
Household Income
# of adults in household
# of children/minors in household
Total household yearly income
$
.00
Source(s) of Income (check all that apply)
Alimony or Spousal Support
Disability- Other
Disability- Social Security (SSDI)
Disability- Veteran
Employment
Family Support
Pension- Other
Pension- Veteran
Social Security- Retirement Income
Social Security- Supplemental Security Income (SSI)
Spousal Employment
Supplemental Nutrition Assistance Program (SNAP)
Temporary Assistance for Needy Families (TANF)
Unemployment
Worker's Compensation