Web Contact Form – Waterloo Region Community Legal Services

Web Contact Form

Please note that questions without an * are optional.

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 *

What is your primary source of income? *

What is your total household income (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 selected Housing from the list above, please provide the name of your landlord.

Brief description of your issue *

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

DISCLAIMER

We reserve the right to request your most recent Notice of Assessment at any time to verify your income and eligibility.