Please fill out the form below and click the "Post" button when you are finished.

Moderate Means Program Client Terms

For the purpose of program assessment, we may contact you or the lawyer you are referred to for information regarding your case. By participating in this program, you agree that the attorney we refer you to may share general information with us about your case, including how the case was resolved and what the final fee agreement was. In addition, you agree that we may share your intake information with lawyers participating in the Moderate Means Program. Please check the box below to show that you consent to these terms. (You will not be allowed to proceed to the application form until you check this box.)

The lawyer you are referred to will charge you fees. The lawyer's time is not a free service. You and the lawyer will negotiate the fee. The lawyer's hourly fee rate will vary. The lawyer will take into account your household income and the number of dependents. The lawyer may request an advance deposit. Be prepared to discuss the hourly fee rate and be prepared to possibly pay a nominal fee upfront.

Below is the sliding fee scale WSBA has suggested to participating lawyers based on the Federal Poverty Level (FPL) scale.

Individual client income 200-250% FPL: reduced hourly fee by 75%
Individual client income 250-350% FPL: reduced hourly fee by 50%
Individual client income 350-400% FP: reduced hourly fee by 25%

*An annual household income lower than approximately $22,900 will not qualify for this Program. Use the Federal Poverty Level (FPL) chart as a guideline for your negotiation with the lawyer. The WSBA Moderate Means Program cannot guarantee a specific fee. You should also tell the lawyer about your assets, debts, and any expenses that you regularly have. The lawyer may require documentation of your income.
Instruction: To request services from the Moderate Means Program, please answer the following questions honestly and to the best of your ability.

Is my legal issue something the Moderate Means Program can help with?

The Moderate Means Program currently provides legal referrals for Family, Housing, and Consumer issues. Please see our website at http://www.moderatemeanswa.org for examples of what these categories include. Select which of these three areas you need help with
Please note: If your legal issue does not fit into one of these areas, the Moderate Means Program may not be able to refer you to a participating lawyer, and you may not receive a call from a law student. Please see www.washingtonlawhelp.org

Demographic Information

First Name
Middle Initial
Last Name
Are you able to easily communicate in English? Yes No
If not, what is your primary language?
Do you require the assistance of an interpreter? Yes No
Date of Birth
Street Address 1
Street Address 2
City
State
Zip
Email Address
Can you receive confidential messages at this email address? Yes No
Home Phone
Can a confidential voice mail message be left at your home phone number? Yes No
Work Phone
Can a confidential voice mail message be left at your work phone number? Yes No
Cell Phone
Can a confidential voice mail message be left at your cell phone number? Yes No
When is the best time to reach you by phone?

Monthly Income

We need to determine if you are financially eligible for the Moderate Means Program.
What is the source of your income? List the amounts from all sources of income that you and members of your household receive each month before taxes. Pick all that apply:
Wages $
Spousal support $
Child support $
Veteran's benefits $
Unemployment $
SSI/SSDI $
TANF $
Other aid/public benefits $
Retirement/investment income $
Other $
Total Income: $ 

Assets

Do you currently own the house you live in?
Do you own any other real estate, either with a home on it or without?
How much do you have in the bank (checking or savings accounts)? $
Do you have other investments, such as stocks or bond?