Book Ask-A-Lawyer: Military

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First Name

Last Name

Cell

Advocate's Name (First, Last) AND email address

Offender's Name, Date of Birth, AND Relationship to Applicant

Does the applicant or offender have a military connection? (Veteran, Active Duty, Dependent, DOD civilian). Or did the incident happen on a military base?

Type of victimization

Is the applicant involved in any current court cases? If so, please provide any case numbers, next court dates, and whether he or she is represented by an attorney.

(For Advocate) Applicant has been explained and, if requested, referred to housing

(For Advocate) Applicant has been explained and, if requested, referred to counseling services

(For Advocate) I have a signed "Release of Information" from the applicant allowing me to submit information to TESSA Legal Services.

(For Advocate) I have read and explained the following to the applicant: The information provided in this form is to determine eligibility for legal services only and does not create an attorney-client relationship.

I understand that confirmation of this appointment booking is subject to Matthew Beresky, or their law firm, completing a conflict check.