Legal Intake Form Please fill out and submit the legal intake form. Legal Intake Form Which Office Would You Like to Get Legal Services From?(Required)FremontLos AngelesSan JoseFirst Name(Required) Middle Name Last Name(Required) A# (USCIS #)Street Address(Required) City(Required) Zip Code(Required) County you live in Birth Date (Month/Date/Year)(Required) Country of Citizenship(Required) Race/Ethnicity(Required) Country of Birth(Required) Email Address(Required) Phone Number(Required)Primary Language Sexual Orientation(Required)Straight or heterosexualBisexualGay or LesbianQueerAnother sexual orientationUnknownDecline to StateGender Identity(Required)MaleFemaleNon-Binary (neither male nor female)Transgender: Female to MaleTransgender: Male to femaleAnother Gender IdentityDecline to StateEducation(Required)None or did not complete primary schoolCompleted primary schoolCompleted secondary schoolSome collegeCompleted collegeUnknownImmigration StatusU.S. CitizenLPROthersAge Group5-910-1415-1920-2930-3940-4950-5960-6970-7980+To better serve you, please describe why you are here today and what kind of assistance you need?(Required)Have you previously contacted Pars about this matter? If yes, who?Do you consent to us contacting you and inviting you to future legal events via email?(Required)YesNoLimited Legal Advice Agreement & Privacy Waiver(Required) Agree I understand and agree that the services that I will receive today from Pars Equality Center (Pars) Attorneys, OLAP/DOJ Accredited Representative(s), Volunteer(s), Contractors, Agents or Assignees indicated below, will be limited to providing me with a consultation/assistance with form filling. I understand that person listed below who is assisting me will not be representing me in my immigration case, and no attorney-client relationship will be established. I agree to provide complete and truthful information in the course of this assistance. I authorize Pars, its offices, employees, contractors, volunteers, agents, and assignees to share the information on this intake form with their grantors/funders for the sole purpose of grant reporting requirements. I agree to release and hold harmless Pars, its offices, employees, contractors, volunteers, agents, and assignees, from any and all claims of action or damages of any kind arising from, or in any way connected to, the release or use of any information pursuant to this Privacy Waiver. Applicant's Name(Required) First Last