Victim Rights Law Center Online Client Application

1Acknowledgement

2Basic Information

3Immigration Practice Acknowledgement

4Family Law Practice Acknowledgement

5Acknowledgement

6Acknowledgement

7Acknowledgement

8Acknowledgement

9Survivor Name

10Perpetrator Information

11Survivor Demographics

12Survivor Contact Information

13Upcoming Hearings

In order to apply, you will need to give us personal information about yourself, your household, and the nature of your legal problem.

We only use this information to figure out if you qualify for our legal aid services. We will not share any of this information without asking you first.

Please understand that submitting an application does not guarantee that Victim Rights Law Center can take your case. Submitting an application does not create an attorney-client relationship.

Acknowledgement(Required)

I understand and would like to continue.

I am looking for help with...(Required)

Please note that VRLC's services are limited to survivors of rape, sexual assault, and stalking of a sexual nature. If you are not sure if you qualify, please select "Unsure."

Rape

Sexual Assault

Stalking of a sexual nature

Unsure

Something Else

Please provide a brief description.(Required)

Is your legal issue in Massachusetts?(Required)

If you are unsure, but you live in Massachusetts, please select "yes."

Yes

Are you applying for services for yourself or for someone else?(Required)

Myself

Someone else

What is your relationship to the survivor?(Required)

Parent/Guardian

Advocate or other referring agency

Family member

Friend

Other

Is the survivor aware that you are applying for services on their behalf?(Required)

Yes

Is the survivor under the age of 18?(Required)

Yes

Please select the legal area(s) you are looking for help with.(Required)

Privacy

Safety

Protection Order (258E/209A)

Education (in a K-12 school)

Education (in college or other higher education)

Immigration

Housing

Employment

Applying for Victim Compensation or Public Benefits

Name or Gender Change Petitions

Navigating the Criminal Justice System

Family Law (divorce or child custody)

I'm not sure

Please note that VRLC is unable to take new immigration cases, but may be able to help with your other legal concerns. Our team will still provide referrals for help with Immigration matters.

Acknowledgement(Required)