You can request assistance by completing the inquiry form below, contacting your local LSNC office or calling our toll-free disaster line at (800) 660-3458. We review and respond to requests in the order they are received. Please note any deadlines. By submitting this form, you understand that Legal Services of Northern California is not agreeing to represent you in any matter, or otherwise agreeing to take on your case.

Contact Information

Are you looking for help for yourself or for someone else (spouse, parent, etc.)?

What is the name of the person completing this form?

What is the best telephone number to reach you?

Please enter a valid phone number in the format (999) 999-9999.

What is your email address?

Please complete the remaining questions on this form for the person for whom you are requesting help.

First Name

Last Name

Street Address

City

State

Zip

Cell Phone

Home Phone

Work Phone

Other Phone

How did you hear about us?

Information about Disaster

What is your county of residence?

If different, what is the county where the disaster happened?

What natural disaster caused your legal question? When did it happen?

Please describe your legal issue and indicate any deadlines.

Personal Information

Marital Status

Type of Housing

How many people live in your household?

Estimated Monthly Household Income (Please enter a dollar amount))

What is your gender identity?

Add other gender information here

Primary Language:

Do you identify as a person with disabilities?

Disability description

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Do you have any related document you wish you upload?

If you have related documents, you may attach up to four here.

Contact Information