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					          COURT ASSISTANCE OFFICE CONTACT FORM
                                   TELEPHONE INQUIRY
NAME: ______________________________________________________________________________________

ADDRESS: ___________________________________________________________________________________

PHONE NUMBER: ________________________ WHEN AVAILABLE: _________________________________

DATE: ____________ HOW DID THEY HEAR ABOUT THIS OFFICE? ________________________________

___ ORALLY PROVIDED NOTICE REGARDING COURT ASSISTANCE OFFICE

AGREED TO A BREIF EVALUATION SURVEY ABOUT THE SERVICES RECEIVED AT THE COURT
ASSISTANCE OFFICE? ____ Yes ____ No ____ Not discussed

TYPE OF CASE:

____ Divorce ( ____ with children ____without children )
____ Paternity
____ Parenting plan agreement/modification
____ Child support modification
____ Contempt (parenting plan or child support agreement)
____ Parental kidnapping
____ Separation agreement
____ Protection order
____ Name change
____ Small Claims
____ Domestic Violence
____ Other—please specify: ______________________________________________________________________

      ________________________________________________________________________________________

IN THIS ACTION, YOU ARE THE:              ____ Plaintiff/petitioner   ____ Defendant/respondent

HAVE YOU FILED ANY DOCUMENTS TO INITIATE OR RESPOND TO THIS ACTION?

____ No
____ Yes—please specify: _______________________________________________________________________

      ________________________________________________________________________________________

HAS THE ADVERSE PARTY/PARTIES BEEN REPRESENTED BY IDAHO LEGAL AID SERVICES, THE
UNIVERSITY OF IDAHO LEGAL AID CLINIC, OR IDAHO VOLUNTEER LAWYERS PROGRAM IN THE PAST?

____ No
____ Yes—please specify: _______________________________________________________________________

     _________________________________________________________________________________________

DO YOU KNOW WHAT FORMS ARE NEEDED TO INITIATE OR RESPOND TO THIS ACTION?

____ No
____ Yes—please specify: _______________________________________________________________________
WHAT KIND OF HELP ARE YOU SEEKING TODAY?

____ Information on this action
____ Information on what forms are needed to initiate or respond to this action
____ Instructions for completing the necessary forms
____ Review of forms after completion
____ Information on attorneys fees, or free and reduced-rate legal assistance
____ Information on what other assistance or resources are available to you
____ Other—please specify: ______________________________________________________________________

      _________________________________________________________________________________________

_____________________________________________________________________________________________
                                   OPTIONAL INFORMATION
            (Please complete if seeking information on free or reduced-rate legal services)

Household’s total income is: _____________________ per month / per year (circle one)

The total number of individuals in household is: _______________________


Time in: _______________ AM / PM           Time out: _______________ AM / PM

Referrals made: ____ ILAS   ____ IVLP   ____ U of I Clinic   ____ Other—specify: ________________________________

Service rendered:

         ____ Mailed intake form and brochure
         ____ Mailed CAO forms order form
         ____ Provided information on how to proceed with this action
         ____ Provided information on what forms are needed to initiate or respond to this action
         ____ Provided instructions or referred for assistance in completing forms
         ____ Reviewed forms after completion
         ____ Provided information on attorneys fees, or free and reduced-rate legal assistance
         ____ Provided information on other assistance or resources available
         ____ Other—please specify: ________________________________________________________________________

              ___________________________________________________________________________________________


Notes: __________________________________________________________________________________________________

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