Applicant Intake Form for Patriot Thursdays Development

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Applicant Intake Form for American Legion 139 Appointment

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:

I must meet certain eligibility requirements and that, for educational and other reasons, an appointment opportunity may not be extended.
M-VETS is independent of the Department of Defense, Department of Veterans Affairs, and the American Legion. M-VETS will decide whether to extend an appointment opportunity, without the recommendation of any of the aforementioned entities.
All services provided will be provided for free.
M-VETS will notify me to schedule an appointment at the M-VETS advice and referral office located at American Legion Post 139.
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 Virginia 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

Virginia Civil Matter

Military Legal Issue

Will/Power of Attorney

VA Benefits-Disability

VA Benefits-Other than Disability

Other

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.

Check here if you have more documents.

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