Web Contact Form – Waterloo Region Community Legal Services

Web Contact Form

🔔 We collect this information to assess your eligibility for our services.
As an income-tested program, we reserve the right to request your most recent Notice of Assessment to verify financial eligibility. Thank you for your understanding.

Fields marked with an asterisk (*) are required.

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First and Last Name *

Date of Birth (DD/MM/YY) *

Phone Number *

Email Address *

Do you consent for us to contact you by e-mail? *

Street Address *

Unit Number (if applicable)

City *

Postal Code *

Do you identify as First Nation (Status or Non Status), Metis or Inuit? *

If yes, would you like to be contacted by the Indigenous Justice Coordinator to learn about additional services?

is description assistance

Do you require any accommodations? (e.g. hearing impairment, language interpretation, e-mail only, etc.)

What is your primary source of income? *

What is your total annual household income prior to tax deductions (e.g. spouse/partner's income, employment income, pensions, inheritances, etc.)? *

If you selected employment, please indicate your family size. *

What area of law do you need assistance with? *

If you need assistance with Housing law, please provide the name of your landlord. If you DO NOT need assistance with Housing law, please type: N/A. *

Brief description of your issue *