LEGAL AID SOCIETY OF MILWAUKEE, INC.
Staff Intake form
(Attach to Client Intake Form)
Date: Staff Name:
Client Name: Case Code: (see list on back)
Conflict Reviewed:No MatchFormer Client Possible Conflict
Further Check Required Referral to Conflict Committee
Upcoming hearing or deadline:
Adverse Parties:
Project:ALERT HELP OATH SOLACE TACS
ALINE AMVETS GENERAL CIVIL
Homeless: Yes No English as a Second Language: Yes No
Veteran: Yes NoBranch:
ACTION TO BE TAKEN
CATEGORY# ______ OPEN CASE FILEBRIEF SERVICE
Advice/Counsel Referral Investigation Educational Information
Comments:
Information offered:
Tax Problems/EITC Life PlanningOther:
Reason for Declining Case:
Lacks Merit Over Income Case Type Residence
Case Codes
1 CCGAL - CC Guardian Ad Litem2 Advanced Directives
3 Appeal - Civil Rights
4 Appeal - DT GAL
5 Appeal - Mental Disability Law
6 Bankruptcy - Consumer Law
7 Change Placement - DT GAL
8 Change Placement Family Law
9 Child Abuse - DT GAL
10 Child Abuse - Family Law
11 Child Support - DT GAL
12 Child Support - Family Law
13 Concealed Weapon - Muni. Ord.
14 Consumer Law
15 Contempt - Civil Rights
16 Contempt - DT GAL
17 Contempt - MDL
18 Custody - DT GAL
19 Custody - Family Law
20 Disability - Administrative
21 Disorderly Conduct - Muni Ord.
22 Divorce - DT GAL
23 Divorce - Family Law
24 Domestic Violence - GAL
25 Domestic Violence - Family
26 Employment Discrimination
27 Estate - Administrative
28 Eviction - Housing Law
29 Federal Civil Rights
30 Food Stamps - Administrative
31 Guardianship - CC GAL
32 Guardianship - DT GAL
33 Guardianship - Family Law
34 Harassment - Civil Rights
35 Harassment - DT GAL
36 Health Insurance - Admin.
37 Hindering - Muni. Ord.
38 House of Correction - Muni. Ord.
39 Housing Code Violation
40 Housing Discrimination
41 Immigration - Administrative
42 Legal Separation - DT GAL
43 Legal Separation - Family Law
44 Loitering - Municipal Ordinance / 45 Medicaid - Administrative
46 Mental Commitment - DT GAL
47 Mental Commitment - MDL
48 Municipal Ordinance
49 Other - Miscellaneous
50 Paternity - DT GAL
51 Paternity - Family Law
52 Protective Placement - MDL
53 Retail Theft - Muni Ordinance
54 Security Deposit
55 Small Claims - Consumer Law
56 SSD - Administrative
57 SSI - Administrative
58 Unemployment Administrative
59 Utilities - Consumer Law
60 Vandalism - Muni Ordinance
61 Visitation - DT GAL
62 Visitation - Family Law
63 W-2 - Administrative
64 WATTS - Mental Disability Law
65 Welfare - Administration
66 Tax Counseling
67 Foreclosure Counseling
68 Municipal - Traffic
69 Municipal - Warrants
70 Worker=s Compensation
71 SSI Overpayment
72 SSD Overpayment
73 SSA - Payee
74 SSA - Retirement
75 Medicare
76 Pension
77 Insurance
78 Appeal Administrative
79 Veteran=s Benefits
80 Estate - Will
81 Estate - Living Will
82 Estate - Trust
83 Power of Attorney - Financial
84 Power of Attorney - Health
85 Consumer - Contract
86 Consumer - Identity Theft
87 Housing - Landlord/Tenant
88 Housing - Public Housing / 89 Employment - Wrongful Term.
90 Other - Administrative
91 Other - Civil Rights
92 Other - Consumer Law
93 Other - Housing Law
94 Other - Family Law
95 Other - Mental Disability
96 Other - Miscellaneous
97 Other - Municipal
98 Criminal
99 Inmate - Prison
100 Inmate - Jail
Race Codes:
A - Asian
N - Native American
B - Black
O - Other/Unknown
H - Hispanic
W - White