Applicant Intake Form for Military Matters

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Applicant Intake Form for Military Matters

Please read the following carefully, and acknowledge your understanding.

In seeking assistance from the Antonin Scalia Law School Mason Veterans
and Servicemembers Legal Clinic (M-VETS), I understand that:

If my case is accepted, I will be represented by law students under the supervision of licensed attorneys.
I must meet certain eligibility requirements and that, for educational and other reasons, my case may not be accepted.
M-VETS is independent of the Department of Defense and Department of Veterans Affairs. M-VETS will decide whether to recommend an attorney to supervise M-VETS student(s) representing my interests, not those of the Department of Defense, Department of Veterans Affairs or the United States government.
Representation is free, but incidental costs such as administrative costs and filing fees will be my responsibility.
M-VETS will notify me as soon as possible of its decision to accept or decline my case. If M-VETS has requested that I provide additional documents or information, I agree to comply as soon as possible so that M-VETS may make a final decision about whether to assist me. I further understand that by requesting additional documents, M-VETS has not accepted my case or agreed to represent me.
Prior to undertaking representation, M-VETS will prepare an engagement letter detailing the agreement between the clinic and myself and each party’s responsibilities during the course of the representation. I further understand that I am not a client of the clinic until I sign the engagement letter and return it to M-VETS. Unless and until then, if I have pending deadlines, it is my responsibility to ensure I comply with those deadlines.
The law student assigned to my case may be substituted by another M-VETS student-advisor at the discretion of the clinic director at any time.
M-VETS reserves the right to terminate its representation of me for various reasons set forth in the engagement letter. These reasons could include, but are not limited to, my intentional or negligent misrepresentation or omission of materials regarding my case, or my failure to provide requested documents or information or otherwise assist with my case. If M-VETS terminates representation, it will do so pursuant to the procedures outlined in the engagement letter and consistent with the Illinois Rules of Professional Responsibility.
All information and/or documents that I provide to M-VETS will be protected and kept confidential pursuant to and consistent with the requirements of Rules 1.6 and 1.18 of the Illinois Rules of Professional Responsibility.
Under the Code of Virginia Chapter 39, Article 1 General Provisions, § 54.1-3900.02. Disclosure of services provided by the Department of Veterans Services. Attorneys who hold accreditation from the U.S. Department of Veterans Affairs to assist veterans with VA-related claims and appeals processes shall provide a written disclosure informing all clients of the free services offered by the Department of Veterans Services for service members, veterans, and their families. I acknowledge that I have been provided written notice that the Department of Veterans Affairs offers free services for service members, veterans, and their families concerning VA-related claims and appeals processes.

By checking this box, I acknowledge that I understand and accept the above terms and conditions.

First Name:

Last Name:

Address:

Apt, Suite, etc.:

Country:

City:

State:

Zip Code:

Best contact number:

Email:

Annual Household Income:

Military/Veteran Status:

Branch of Service:

Pay Grade:

Are you a Combat-Veteran?

Current Unit of Assignment
(if any) and installation:

Proof of Service:

Proof Type:

How did you hear about the
Mason Veterans and
Servicemembers Legal
Clinic (M-VETS)?

Do you have legal issues
requiring immediate
attention?

Please indicate the area(s) of legal services you are seeking by checking
the appropriate boxes (must check at least one):

BCMR Representation

Discharge Upgrade

MEB Representation

Military Legal Issue

PEB Representation

VA Benefits-Disability

VA Benefits-Other than Disability

Short description of issue(s)
and assistance sought:

Please note any documents
already served, pending
court or hearing dates, etc.:

Have you sought other legal
assistance with these issues?

Are you currently represented
by an attorney or organization
for this matter?

Upload all relevant documents.

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