Si vous êtes humain, laissez ce champ vide.NOVA SCOTIA LEGAL AID ONLINE APPLICATION FORMLast Name *First Name *Middle NameMaiden NamePreferred Name(s)Your preferred name may not be your legal first name. What would you like us to call you?Gender PronounsFor example: she / he / they / zie Street AddressCity/TownAptProvince *Nova ScotiaAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonPostal CodePO BoxContact Methods *Please indicate the way you wish to be contacted in order. If you want to be contacted via text message (SMS) please indicate your cell/text provider as we need this to text you. We MUST have a method to contact you to process your application. For example: Cell phone (902) 555-1212 Text Message (902) 555-1212 AND Cell Company Email somebody@somemail.com Date of Birth *Sex *MaleFemaleOtherMarital Status *SingleMarriedCommon-LawSeparatedDivorcedWidowedAre you a Canadian citizen? *YesNoI self-identify as Indigenous (First Nation, Métis, Inuit) *YesNoI self-identify as Black or African-Nova Scotian *YesNoI do not self-identify as either of these groups, or choose not to self-identify. *YesNoFinancial InformationIncome Source *If you have multiple sources of income please check all that apply.Full-Time EmployedPart-Time EmployedSelf-EmployedIncome Assistance / Municipal AssistanceOld Age AssistanceWorker's CompensationCPP DisabilityPensionUnemployedStudentNo incomeEmployer or Name of Person who can verify your financial information:Phone Number:Are you CURRENTLY in jail? *YesNoDo you have children that you support financially or are under the age of 19? *YesNoNumber of Children: Child 1NameDate of Birth:Who does the child live with? Child 2NameDate of Birth:Who does the child live with? Child 3NameDate of Birth:Who does the child live with? Child 4NameDate of Birth:Who does the child live with? Child 5NameDate of Birth:Who does the child live with? Child 6NameDate of Birth:Who does the child live with? Child 7NameDate of Birth:Who does the child live with? Child 8NameDate of Birth:Who does the child live with? What type of legal matter do you have? *Nova Scotia Legal Aid handles a variety of different legal matters for Nova Scotians. FAMILY - separation, divorce, custody, access, child support, alimony, Child Protective Services/Mi'Kmaw Family and Children Services. CRIMINAL - criminal charges have been laid against you or will be laid, includes traffic offences. SOCIAL JUSTICE - EI, CPP, Income Assistance, disability, residential tenancies. OTHER - NSLA may assist with other matters, as per our website.FamilyCriminalSocial JusticeOther FAMILY LAWWhy do you need help? *Please indicate briefly why you need help. Do not go into great detail - you have only 180 characters (2 lines)CPS/MMFS *Do you require legal assistance due to Child Protective Services or Mi'Kmaw Family & Children Services of Nova Scotia being involved with your family?YesNoType of CPS/MMFS MatterFive Day HearingThirty Day HearingNinety Day Protection HearingDisposition HearingOther matter not listed aboveName of Opposing Party: *All family matters have at least two sides. Who is the opposing party in your matter? If you have a date of birth for them this would also be helpful.Do you have a yellow card?A yellow card is a card given to you by social services. If you were given one in relation to this matter please select yes.YesNo Criminal Law:Is your criminal charge subject to the Youth Criminal Justice Act? *Were you under the age of 18 years of age on the date(s) when the police think you committed an offence?YesNoCharges: *What have YOU been charged with or do you anticipate being charged with? Do not fill in someone else's charges here (for example, if your estranged spouse is being charged with domestic violence).Name of Opposing Party: *Who is the complainant(s) in your case, or the alleged victim(s)? If you have a date of birth for them this would also be helpful. Social Justice Law:Select the type of Social Justice Matter you have: *Canada Pension Disability (CPP)Employment Insurance (EI, CERB)Income Assistance (IA)Residential Tenancies and other Landlord/Tenant mattersName of Opposing Party: *All social justice matters have at least two sides. Who is the opposing party in your matter? If you have a date of birth for them this would also be helpful. *Please briefly describe the matter you need help with. Please note that Nova Scotia Legal Aid does not provide services in all matters. Please see our website for full details on what type of matters we provide services for. What we do - What Legal Services Provided Other Matters:Other Matters: *Please briefly describe the matter you need help with. Please note that Nova Scotia Legal Aid does not provide services in all matters. Please see our website for full details on what type of matters we provide services for. What we do - What Legal Services Provided Court InformationCourt Location (City/Town)Next Court DateTime Who do you live with?Husband/WifeCommon Law SpouseParent/GuardianBy MyselfOther: Their names and phone numbers:Have you received Nova Scotia Legal Aid before? *Please note: This does not include Dalhousie Legal Aid or any out of province Legal Aid.Yes (I had the same name I do now)Yes (I had a different name at the time)NoIf you had a different name the last time you had Legal Aid, what was it?Has your family or financial situation changed?If your family or financial situation hasn't changed since the last time you had legal aid please note this - this may help to speed up your application process.YesNoWhat Nova Scotia Legal Aid office did you receive help from?NoneAmherstAnnapolis RoyalAntigonishBridgewaterDartmouth CRIMINAL LAWDartmouth FAMILY LAWHalifax ADULT CRIMINAL LAWHalifax FAMILY LAWHalifax SOCIAL JUSTICE LAWHRM Youth OfficeKentvilleNew GlasgowPort HawkesburySydney Conflict OfficeSydney CRIMINAL LAWSydney FAMILY LAWTruroWindsorYarmouthNote: If you had a certificate lawyer, you would have seen or been referred by one of the offices below first. When did you receive help? (Month and year is adequate).I would like a copy of my application sent to me: *YesNoTo what email address? Declaration and Contact AuthorizationREAD DECLARATION AND AUTHORIZATION CAREFULLY: By typing your name below and pressing submit: The applicant declares that information provided is true and complete. The applicant will provide additional information as required. The applicant consents to have information investigated for verification. The applicant must notify Nova Scotia Legal Aid of any changes in financial circumstances or living arrangements - failure to comply may result in termination of services. The applicant authorizes Nova Scotia Legal Aid to represent and act for Applicant in the matter mentioned or any related matter and further authorizes Nova Scotia Legal Aid to take any necessary action or obtain required assistance. I authorize Nova Scotia Legal Aid to contact me via email regarding my matter and for feedback purposes: *YesNoI authorize Nova Scotia Legal Aid to contact me via SMS (text message) regarding my matter and for feedback purposes: *YesNoI prefer that NSLA Communicate with me by: *TextEmailLandlineCell PhoneSignature *Today's Date *Submit