CVLAS Online Intake Form

Thank you for reaching out to Central Virginia Legal Aid Society. Please fill out the information on this form and click submit to request legal assistance. If you state that you have a court date or another important deadline in the next 3 business days, we will attempt to review and respond to your application more quickly.

First Name

Middle Name

Last Name

What is the best way to reach you?

Phone Call

Text

What is the best time to reach you?

Please note many staff work between 8:30 am and 4:30 pm. We will do our best to work with your schedule.

Phone

Mailing Address

Street (include Apt. #)

City

State

Zip

CVLAS only can provide assistance in the following counties and cities in Virginia: Albermarle, Charles City, Charlottesville, Chesterfield, Colonial Heights, Dinwiddie, Fluvanna, Goochland, Greene, Hanover, Henrico, Hopewell, Louisa, Nelson, New Kent, Petersburg, Powhatan, Prince George, Richmond (city), and Surry.

Please select only one of the following areas for which you are seeking legal assistance. You may submit additional inquiries for other areas, if needed.

Rental Housing (eviction, lockout, repairs, security deposit, vouchers, rent debt collection)Family (domestic violence, protective order, child custody and visitation, child/spousal support, uncontested divorce)Consumer (bankruptcy, garnishment, debt collection, foreclosure, car repossession)Employment (unemployment compensation, wrongful discharge)Public Benefits (SNAP or food stamps, TANF, Medicaid, SSI)Wills and Powers of Attorney (advance directives (living wills), guardianships/conservatorships)

By clicking the Submit button below, you understand that CVLAS does not represent you unless and until both you and a CVLAS attorney sign a written agreement that says CVLAS will be your lawyer and represent you in the specific matter you are seeking help with.

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