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LSEM Intake

 
1 Start 2 Intake Start 3 Address Information 4 Phone Information 5 Best Time to Contact You 6 Helper Info 7 Household Information 8 Military / Disability Information 9 Other Party Information 10 Lawyer Information 11 Household Income 12 Finish and Submit 13 Complete

We're now going to ask you some questions to see if we can help you. We'll need to know information about you and the people in your household. Answer the questions as best as you can.

When you are finished with each page, click "next page." If you make a mistake and need to go back, click "previous page." Do not use the back button in your browser. At the end, click "submit" and we will review your application.