{"id":15838,"date":"2019-08-14T14:29:39","date_gmt":"2019-08-14T17:29:39","guid":{"rendered":"https:\/\/www.nslegalaid.ca\/oa\/"},"modified":"2020-11-02T15:38:23","modified_gmt":"2020-11-02T19:38:23","slug":"oa","status":"publish","type":"page","link":"https:\/\/www.nslegalaid.ca\/fr\/oa\/","title":{"rendered":"Nova Scotia Legal Aid Online Application"},"content":{"rendered":"<form method=\"post\" enctype=\"multipart\/form-data\" id=\"vfbp-form-19\" class=\"vfbp-form\"><div style=\"display:none;\"><label for=\"vfbp-EMAIL-AN8fuQyoDLXem\">Si vous \u00eates humain, laissez ce champ vide.<\/label><input size=\"25\" autocomplete=\"off\" type=\"text\" name=\"vfbp-EMAIL-AN8fuQyoDLXem\" value=\"\" id=\"\"><\/div><input type=\"hidden\" name=\"_vfb-timestamp-19\" value=\"1777531677\" id=\"\"><input type=\"hidden\" name=\"_vfb-form-id\" value=\"19\" id=\"\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\"><\/div><span class=\"vfb-help-block\"><h1 style=\"text-align: left;\">NOVA SCOTIA LEGAL AID<\/h1>\r\n<h2 style=\"text-align: left;\">ONLINE APPLICATION FORM<\/h2><\/span><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1095\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-3 vfb-fieldType-text\" id=\"vfbField527\"><div class=\"vfb-form-group\"><label for=\"vfb-field-527\" class=\"vfb-control-label\">Last Name <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-527\" class=\"vfb-form-control\" placeholder=\"Current\" required=\"required\" type=\"text\" name=\"vfb-field-527\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-3 vfb-fieldType-text\" id=\"vfbField528\"><div class=\"vfb-form-group\"><label for=\"vfb-field-528\" class=\"vfb-control-label\">First Name <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-528\" class=\"vfb-form-control\" placeholder=\"Not nickname\" required=\"required\" type=\"text\" name=\"vfb-field-528\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-3 vfb-fieldType-text\" id=\"vfbField529\"><div class=\"vfb-form-group\"><label for=\"vfb-field-529\" class=\"vfb-control-label\">Middle Name<\/label><div><input id=\"vfb-field-529\" class=\"vfb-form-control\" placeholder=\"If you have one\" type=\"text\" name=\"vfb-field-529\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-3 vfb-fieldType-text\" id=\"vfbField530\"><div class=\"vfb-form-group\"><label for=\"vfb-field-530\" class=\"vfb-control-label\">Maiden Name<\/label><div><input id=\"vfb-field-530\" class=\"vfb-form-control\" placeholder=\"Before marriage\/change\" type=\"text\" name=\"vfb-field-530\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField1031\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1031\" class=\"vfb-control-label\">Preferred Name(s)<\/label><div><span class=\"vfb-help-block\">Your preferred name may not be your legal first name.  What would you like us to call you?<\/span><input id=\"vfb-field-1031\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1031\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-form-group vfb-col-6\"><div><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-heading\" id=\"vfbField1716\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField1030\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1030\" class=\"vfb-control-label\">Gender Pronouns<\/label><div><span class=\"vfb-help-block\">For example: she \/ he \/ they \/ zie\r\n\r\n<\/span><input id=\"vfb-field-1030\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1030\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-form-group vfb-col-6\"><div><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-heading\" id=\"vfbField1717\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-3 vfb-fieldType-text\" id=\"vfbField544\"><div class=\"vfb-form-group\"><label for=\"vfb-field-544\" class=\"vfb-control-label\">Street Address<\/label><div><input id=\"vfb-field-544\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-544\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-3 vfb-fieldType-text\" id=\"vfbField532\"><div class=\"vfb-form-group\"><label for=\"vfb-field-532\" class=\"vfb-control-label\">City\/Town<\/label><div><input id=\"vfb-field-532\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-532\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-1 vfb-fieldType-text\" id=\"vfbField531\"><div class=\"vfb-form-group\"><label for=\"vfb-field-531\" class=\"vfb-control-label\">Apt<\/label><div><input id=\"vfb-field-531\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-531\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-3 vfb-fieldType-select\" id=\"vfbField1699\"><label for=\"vfb-field-1699\" class=\"vfb-control-label\">Province <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-form-group\"><select id=\"vfb-field-1699\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" name=\"vfb-field-1699\"><option value=\"Nova Scotia\" selected=\"selected\">Nova Scotia<\/option><option value=\"Alberta\">Alberta<\/option><option value=\"British Columbia\">British Columbia<\/option><option value=\"Manitoba\">Manitoba<\/option><option value=\"New Brunswick\">New Brunswick<\/option><option value=\"Newfoundland and Labrador\">Newfoundland and Labrador<\/option><option value=\"Northwest Territories\">Northwest Territories<\/option><option value=\"Nunavut\">Nunavut<\/option><option value=\"Ontario\">Ontario<\/option><option value=\"Prince Edward Island\">Prince Edward Island<\/option><option value=\"Quebec\">Quebec<\/option><option value=\"Saskatchewan\">Saskatchewan<\/option><option value=\"Yukon\">Yukon<\/option><\/select><\/div><\/div><\/div><div class=\"vfb-col-2 vfb-fieldType-text\" id=\"vfbField535\"><div class=\"vfb-form-group\"><label for=\"vfb-field-535\" class=\"vfb-control-label\">Postal Code<\/label><div><input id=\"vfb-field-535\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-535\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-2 vfb-fieldType-text\" id=\"vfbField1966\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1966\" class=\"vfb-control-label\">PO Box<\/label><div><input id=\"vfb-field-1966\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1966\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField1032\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1032\" class=\"vfb-control-label\">Contact Methods <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">Please indicate the way you wish to be contacted in order.\u00a0 If you want to be contacted via text message (SMS) please indicate your cell\/text provider as we need this to text you.  We <b><u>MUST<\/b><\/u> have a method to contact you to process your application.\r\n\r\n<p>For example:\r\n\r\n<li>Cell phone (902) 555-1212<\/li>\r\n<li>Text Message (902) 555-1212 <b>AND <\/b>Cell Company<\/li>\r\n<li>Email &#x73;&#111;&#109;e&#x62;&#x6f;&#100;y&#x40;&#x73;&#111;me&#x6d;&#97;&#105;l&#x2e;&#x63;&#111;m<\/li>\r\n<\/br>\r\n<\/p><\/span><textarea id=\"vfb-field-1032\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" data-vfb-words=\"[2,64]\" rows=\"6\" name=\"vfb-field-1032\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-3 vfb-fieldType-text\" id=\"vfbField1697\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1697\" class=\"vfb-control-label\">Date of Birth <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-1697\" class=\"vfb-form-control\" placeholder=\"mm\/dd\/yyyy\" data-mask=\"00\/00\/0000\" required=\"required\" data-vfb-pattern=\"^(0[1-9]|1[012])[- \/.](0[1-9]|[12][0-9]|3[01])[- \/.](19|20)\\d\\d$\" type=\"text\" name=\"vfb-field-1697\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-3 vfb-fieldType-radio\" id=\"vfbField546\"><label for=\"vfb-field-546\" class=\"vfb-control-label\">Sex <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-546-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-546\" value=\"Male\">Male<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-546-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-546\" value=\"Female\">Female<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-546-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-546\" value=\"Other\">Other<\/label><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-radio\" id=\"vfbField548\"><label for=\"vfb-field-548\" class=\"vfb-control-label\">Marital Status <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-row\"><div class=\"vfb-col-6\"><div class=\"vfb-radio\"><label><input id=\"vfb-field-548-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-548\" value=\"Single\">Single<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-548-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-548\" value=\"Married\">Married<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-548-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-548\" value=\"Common-Law\">Common-Law<\/label><\/div><\/div><div class=\"vfb-col-6\"><div class=\"vfb-radio\"><label><input id=\"vfb-field-548-3\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-548\" value=\"Separated\">Separated<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-548-4\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-548\" value=\"Divorced\">Divorced<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-548-5\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-548\" value=\"Widowed\">Widowed<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField1730\"><label for=\"vfb-field-1730\" class=\"vfb-control-label\">Are you a Canadian citizen? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1730-0\" class=\"\" placeholder=\"\" required=\"required\" checked=\"checked\" type=\"radio\" name=\"vfb-field-1730\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1730-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1730\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField1733\"><label for=\"vfb-field-1733\" class=\"vfb-control-label\">I self-identify as Indigenous (First Nation, M\u00e9tis, Inuit) <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1733-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1733\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1733-1\" class=\"\" placeholder=\"\" required=\"required\" checked=\"checked\" type=\"radio\" name=\"vfb-field-1733\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField1735\"><label for=\"vfb-field-1735\" class=\"vfb-control-label\">I self-identify as Black or African-Nova Scotian <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1735-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1735\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1735-1\" class=\"\" placeholder=\"\" required=\"required\" checked=\"checked\" type=\"radio\" name=\"vfb-field-1735\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField1734\"><label for=\"vfb-field-1734\" class=\"vfb-control-label\">I do not self-identify as either of these groups, or choose not to self-identify. <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1734-0\" class=\"\" placeholder=\"\" required=\"required\" checked=\"checked\" type=\"radio\" name=\"vfb-field-1734\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1734-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1734\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-well vfb-col-12\" id=\"vfbField1719\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\"><\/div><span class=\"vfb-help-block\"><p style=\"text-align: left;\"><strong>Financial Information<\/strong><\/p><\/span><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1719\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField1863\"><label for=\"vfb-field-1863\" class=\"vfb-control-label\">Income Source <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">If you have multiple sources of income please check all that apply.<\/span><div class=\"vfb-row\"><div class=\"vfb-col-4\"><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1863-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1863\" required=\"required\" type=\"checkbox\" name=\"vfb-field-1863[0]\" value=\"1\">Full-Time Employed<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1863-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1863\" type=\"checkbox\" name=\"vfb-field-1863[1]\" value=\"1\">Part-Time Employed<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1863-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1863\" type=\"checkbox\" name=\"vfb-field-1863[2]\" value=\"1\">Self-Employed<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1863-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1863\" type=\"checkbox\" name=\"vfb-field-1863[3]\" value=\"1\">Income Assistance \/ Municipal Assistance<\/label><\/div><\/div><div class=\"vfb-col-4\"><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1863-4\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1863\" type=\"checkbox\" name=\"vfb-field-1863[4]\" value=\"1\">Old Age Assistance<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1863-5\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1863\" type=\"checkbox\" name=\"vfb-field-1863[5]\" value=\"1\">Worker's Compensation<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1863-6\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1863\" type=\"checkbox\" name=\"vfb-field-1863[6]\" value=\"1\">CPP Disability<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1863-7\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1863\" type=\"checkbox\" name=\"vfb-field-1863[7]\" value=\"1\">Pension<\/label><\/div><\/div><div class=\"vfb-col-4\"><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1863-8\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1863\" type=\"checkbox\" name=\"vfb-field-1863[8]\" value=\"1\">Unemployed<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1863-9\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1863\" type=\"checkbox\" name=\"vfb-field-1863[9]\" value=\"1\">Student<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1863-10\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1863\" type=\"checkbox\" name=\"vfb-field-1863[10]\" value=\"1\">No income<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-8 vfb-fieldType-text\" id=\"vfbField1292\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1292\" class=\"vfb-control-label\">Employer or Name of Person who can verify your financial information:<\/label><div><input id=\"vfb-field-1292\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1292\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField1194\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1194\" class=\"vfb-control-label\">Phone Number:<\/label><div><input id=\"vfb-field-1194\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1194\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField559\"><label for=\"vfb-field-559\" class=\"vfb-control-label\">Are you <b><u>CURRENTLY<\/b><\/u> in jail? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-inline-group\"><div class=\"vfb-radio\"><label><input id=\"vfb-field-559-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-559\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-559-1\" class=\"\" placeholder=\"\" required=\"required\" checked=\"checked\" type=\"radio\" name=\"vfb-field-559\" value=\"No\">No<\/label><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-radio\" id=\"vfbField1034\"><label for=\"vfb-field-1034\" class=\"vfb-control-label\">Do you have children that you support financially or are under the age of 19? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1034-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1034\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1034-1\" class=\"\" placeholder=\"\" required=\"required\" checked=\"checked\" type=\"radio\" name=\"vfb-field-1034\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-number\" id=\"vfbField1840\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1840\" class=\"vfb-control-label\">Number of Children:<\/label><div><input id=\"vfb-field-1840\" class=\"vfb-form-control\" placeholder=\"\" data-vfb-pattern=\"[0-9]\" type=\"number\" name=\"vfb-field-1840\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-3\"><div><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-col-3 vfb-fieldType-heading\" id=\"vfbField1676\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1072\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Child 1<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1072\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField580\"><div class=\"vfb-form-group\"><label for=\"vfb-field-580\" class=\"vfb-control-label\">Name<\/label><div><input id=\"vfb-field-580\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-580\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-2 vfb-fieldType-text\" id=\"vfbField1708\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1708\" class=\"vfb-control-label\">Date of Birth:<\/label><div><input id=\"vfb-field-1708\" class=\"vfb-form-control\" placeholder=\"mm\/dd\/yyyy\" data-mask=\"00\/00\/0000\" data-vfb-pattern=\"^(0[1-9]|1[012])[- \/.](0[1-9]|[12][0-9]|3[01])[- \/.](19|20)\\d\\d$\" type=\"text\" name=\"vfb-field-1708\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField1967\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1967\" class=\"vfb-control-label\">Who does the child live with?<\/label><div><input id=\"vfb-field-1967\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1967\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1073\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Child 2<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1073\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField1039\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1039\" class=\"vfb-control-label\">Name<\/label><div><input id=\"vfb-field-1039\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1039\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-2 vfb-fieldType-text\" id=\"vfbField1706\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1706\" class=\"vfb-control-label\">Date of Birth:<\/label><div><input id=\"vfb-field-1706\" class=\"vfb-form-control\" placeholder=\"mm\/dd\/yyyy\" data-mask=\"00\/00\/0000\" data-vfb-pattern=\"^(0[1-9]|1[012])[- \/.](0[1-9]|[12][0-9]|3[01])[- \/.](19|20)\\d\\d$\" type=\"text\" name=\"vfb-field-1706\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField1974\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1974\" class=\"vfb-control-label\">Who does the child live with?<\/label><div><input id=\"vfb-field-1974\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1974\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1074\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Child 3<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1074\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField1038\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1038\" class=\"vfb-control-label\">Name<\/label><div><input id=\"vfb-field-1038\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1038\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-2 vfb-fieldType-text\" id=\"vfbField1705\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1705\" class=\"vfb-control-label\">Date of Birth:<\/label><div><input id=\"vfb-field-1705\" class=\"vfb-form-control\" placeholder=\"mm\/dd\/yyyy\" data-mask=\"00\/00\/0000\" data-vfb-pattern=\"^(0[1-9]|1[012])[- \/.](0[1-9]|[12][0-9]|3[01])[- \/.](19|20)\\d\\d$\" type=\"text\" name=\"vfb-field-1705\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField1973\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1973\" class=\"vfb-control-label\">Who does the child live with?<\/label><div><input id=\"vfb-field-1973\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1973\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1075\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Child 4<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1075\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField1037\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1037\" class=\"vfb-control-label\">Name<\/label><div><input id=\"vfb-field-1037\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1037\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-2 vfb-fieldType-text\" id=\"vfbField1704\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1704\" class=\"vfb-control-label\">Date of Birth:<\/label><div><input id=\"vfb-field-1704\" class=\"vfb-form-control\" placeholder=\"mm\/dd\/yyyy\" data-mask=\"00\/00\/0000\" data-vfb-pattern=\"^(0[1-9]|1[012])[- \/.](0[1-9]|[12][0-9]|3[01])[- \/.](19|20)\\d\\d$\" type=\"text\" name=\"vfb-field-1704\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField1972\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1972\" class=\"vfb-control-label\">Who does the child live with?<\/label><div><input id=\"vfb-field-1972\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1972\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1076\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Child 5<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1076\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField1036\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1036\" class=\"vfb-control-label\">Name<\/label><div><input id=\"vfb-field-1036\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1036\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-2 vfb-fieldType-text\" id=\"vfbField1707\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1707\" class=\"vfb-control-label\">Date of Birth:<\/label><div><input id=\"vfb-field-1707\" class=\"vfb-form-control\" placeholder=\"mm\/dd\/yyyy\" data-mask=\"00\/00\/0000\" data-vfb-pattern=\"^(0[1-9]|1[012])[- \/.](0[1-9]|[12][0-9]|3[01])[- \/.](19|20)\\d\\d$\" type=\"text\" name=\"vfb-field-1707\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField1971\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1971\" class=\"vfb-control-label\">Who does the child live with?<\/label><div><input id=\"vfb-field-1971\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1971\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1077\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Child 6<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1077\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField1065\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1065\" class=\"vfb-control-label\">Name<\/label><div><input id=\"vfb-field-1065\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1065\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-2 vfb-fieldType-text\" id=\"vfbField1703\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1703\" class=\"vfb-control-label\">Date of Birth:<\/label><div><input id=\"vfb-field-1703\" class=\"vfb-form-control\" placeholder=\"mm\/dd\/yyyy\" data-mask=\"00\/00\/0000\" data-vfb-pattern=\"^(0[1-9]|1[012])[- \/.](0[1-9]|[12][0-9]|3[01])[- \/.](19|20)\\d\\d$\" type=\"text\" name=\"vfb-field-1703\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField1970\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1970\" class=\"vfb-control-label\">Who does the child live with?<\/label><div><input id=\"vfb-field-1970\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1970\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1078\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Child 7<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1078\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField1064\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1064\" class=\"vfb-control-label\">Name<\/label><div><input id=\"vfb-field-1064\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1064\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-2 vfb-fieldType-text\" id=\"vfbField1702\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1702\" class=\"vfb-control-label\">Date of Birth:<\/label><div><input id=\"vfb-field-1702\" class=\"vfb-form-control\" placeholder=\"mm\/dd\/yyyy\" data-mask=\"00\/00\/0000\" data-vfb-pattern=\"^(0[1-9]|1[012])[- \/.](0[1-9]|[12][0-9]|3[01])[- \/.](19|20)\\d\\d$\" type=\"text\" name=\"vfb-field-1702\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField1969\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1969\" class=\"vfb-control-label\">Who does the child live with?<\/label><div><input id=\"vfb-field-1969\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1969\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1079\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Child 8<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1079\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField1063\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1063\" class=\"vfb-control-label\">Name<\/label><div><input id=\"vfb-field-1063\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1063\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-2 vfb-fieldType-text\" id=\"vfbField1701\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1701\" class=\"vfb-control-label\">Date of Birth:<\/label><div><input id=\"vfb-field-1701\" class=\"vfb-form-control\" placeholder=\"mm\/dd\/yyyy\" data-mask=\"00\/00\/0000\" data-vfb-pattern=\"^(0[1-9]|1[012])[- \/.](0[1-9]|[12][0-9]|3[01])[- \/.](19|20)\\d\\d$\" type=\"text\" name=\"vfb-field-1701\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField1968\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1968\" class=\"vfb-control-label\">Who does the child live with?<\/label><div><input id=\"vfb-field-1968\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1968\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1059\"><div class=\"vfb-form-group vfb-col-6\"><div><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-heading\" id=\"vfbField1059\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField551\"><label for=\"vfb-field-551\" class=\"vfb-control-label\">What type of legal matter do you have? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">Nova Scotia Legal Aid handles a variety of different legal matters for Nova Scotians. \r\n\r\nFAMILY - separation, divorce, custody, access, child support, alimony, Child Protective Services\/Mi'Kmaw Family and Children Services.\r\nCRIMINAL - criminal charges have been laid against you or will be laid, includes traffic offences.\r\nSOCIAL JUSTICE - EI, CPP, Income Assistance, disability, residential tenancies.\r\nOTHER -  NSLA may assist with other matters, as per our website.<\/span><div class=\"vfb-radio\"><label><input id=\"vfb-field-551-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-551\" value=\"Family\">Family<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-551-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-551\" value=\"Criminal\">Criminal<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-551-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-551\" value=\"Social Justice\">Social Justice<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-551-3\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-551\" value=\"Other\">Other<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1033\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">FAMILY LAW<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1033\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField562\"><div class=\"vfb-form-group\"><label for=\"vfb-field-562\" class=\"vfb-control-label\">Why do you need help? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">Please indicate briefly why you need help.   Do not go into great detail - you have only 180 characters (2 lines)<\/span><textarea id=\"vfb-field-562\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" rows=\"2\" name=\"vfb-field-562\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField1082\"><label for=\"vfb-field-1082\" class=\"vfb-control-label\">CPS\/MMFS <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">Do you require legal assistance due to Child Protective Services or Mi'Kmaw Family & Children Services of Nova Scotia being involved with your family?<\/span><div class=\"vfb-radio\"><label><input id=\"vfb-field-1082-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1082\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1082-1\" class=\"\" placeholder=\"\" required=\"required\" checked=\"checked\" type=\"radio\" name=\"vfb-field-1082\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField1315\"><label for=\"vfb-field-1315\" class=\"vfb-control-label\">Type of CPS\/MMFS Matter<\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1315-0\" class=\"\" placeholder=\"\" type=\"radio\" name=\"vfb-field-1315\" value=\"Five Day Hearing\">Five Day Hearing<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1315-1\" class=\"\" placeholder=\"\" type=\"radio\" name=\"vfb-field-1315\" value=\"Thirty Day Hearing\">Thirty Day Hearing<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1315-2\" class=\"\" placeholder=\"\" type=\"radio\" name=\"vfb-field-1315\" value=\"Ninety Day Protection Hearing\">Ninety Day Protection Hearing<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1315-3\" class=\"\" placeholder=\"\" type=\"radio\" name=\"vfb-field-1315\" value=\"Disposition Hearing\">Disposition Hearing<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1315-4\" class=\"\" placeholder=\"\" type=\"radio\" name=\"vfb-field-1315\" value=\"Other matter not listed above\">Other matter not listed above<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField570\"><div class=\"vfb-form-group\"><label for=\"vfb-field-570\" class=\"vfb-control-label\">Name of Opposing Party: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">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.<\/span><input id=\"vfb-field-570\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-570\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField1861\"><label for=\"vfb-field-1861\" class=\"vfb-control-label\">Do you have a yellow card?<\/label><div><span class=\"vfb-help-block\">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.<\/span><div class=\"vfb-radio\"><label><input id=\"vfb-field-1861-0\" class=\"\" placeholder=\"\" type=\"radio\" name=\"vfb-field-1861\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1861-1\" class=\"\" placeholder=\"\" checked=\"checked\" type=\"radio\" name=\"vfb-field-1861\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1080\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Criminal Law:<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1080\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField611\"><label for=\"vfb-field-611\" class=\"vfb-control-label\">Is your criminal charge subject to the Youth Criminal Justice Act? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">Were you under the age of 18 years of age on the date(s) when the police think you committed an offence?<\/span><div class=\"vfb-inline-group\"><div class=\"vfb-radio\"><label><input id=\"vfb-field-611-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-611\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-611-1\" class=\"\" placeholder=\"\" required=\"required\" checked=\"checked\" type=\"radio\" name=\"vfb-field-611\" value=\"No\">No<\/label><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField563\"><div class=\"vfb-form-group\"><label for=\"vfb-field-563\" class=\"vfb-control-label\">Charges: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">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).<\/span><textarea id=\"vfb-field-563\" class=\"vfb-form-control\" placeholder=\"Do not go into great detail - you have only 180 characters (2 lines)\" required=\"required\" rows=\"3\" name=\"vfb-field-563\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField1709\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1709\" class=\"vfb-control-label\">Name of Opposing Party: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">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.<\/span><input id=\"vfb-field-1709\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-1709\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1679\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Social Justice Law:<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1679\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField1680\"><label for=\"vfb-field-1680\" class=\"vfb-control-label\">Select the type of Social Justice Matter you have: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1680-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1680\" value=\"Canada Pension Disability (CPP)\">Canada Pension Disability (CPP)<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1680-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1680\" value=\"Employment Insurance (EI, CERB)\">Employment Insurance (EI, CERB)<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1680-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1680\" value=\"Income Assistance (IA)\">Income Assistance (IA)<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1680-3\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1680\" value=\"Residential Tenancies and other Landlord\/Tenant matters\">Residential Tenancies and other Landlord\/Tenant matters<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField1714\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1714\" class=\"vfb-control-label\">Name of Opposing Party: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">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.<\/span><input id=\"vfb-field-1714\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-1714\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField564\"><div class=\"vfb-form-group\"><label for=\"vfb-field-564\" class=\"vfb-control-label\"> <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">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.   <a href=\"https:\/\/www.nslegalaid.ca\/what-we-do\/what-legal-services-provided\/\" target=\"new\">What we do - What Legal Services Provided<\/a><\/span><textarea id=\"vfb-field-564\" class=\"vfb-form-control\" placeholder=\"Do not go into great detail - you have only 180 characters (2 lines)\" required=\"required\" rows=\"2\" name=\"vfb-field-564\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1682\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Other Matters:<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1682\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField1681\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1681\" class=\"vfb-control-label\">Other Matters: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">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.   <a href=\"https:\/\/www.nslegalaid.ca\/what-we-do\/what-legal-services-provided\/\" target=\"new\">What we do - What Legal Services Provided<\/a><\/span><textarea id=\"vfb-field-1681\" class=\"vfb-form-control\" placeholder=\"Do not go into great detail - you have only 180 characters (2 lines)\" required=\"required\" rows=\"2\" name=\"vfb-field-1681\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1089\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Court Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1089\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField1678\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1678\" class=\"vfb-control-label\">Court Location (City\/Town)<\/label><div><input id=\"vfb-field-1678\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1678\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-3 vfb-fieldType-text\" id=\"vfbField1712\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1712\" class=\"vfb-control-label\">Next Court Date<\/label><div><input id=\"vfb-field-1712\" class=\"vfb-form-control\" placeholder=\"mm\/dd\/yyyy\" data-mask=\"00\/00\/0000\" data-vfb-pattern=\"^(0[1-9]|1[012])[- \/.](0[1-9]|[12][0-9]|3[01])[- \/.](19|20)\\d\\d$\" type=\"text\" name=\"vfb-field-1712\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-3 vfb-fieldType-text\" id=\"vfbField1711\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1711\" class=\"vfb-control-label\">Time<\/label><div><input id=\"vfb-field-1711\" class=\"vfb-form-control\" placeholder=\"00:00 am\/pm\" type=\"text\" name=\"vfb-field-1711\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1083\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1083\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-checkbox\" id=\"vfbField566\"><label for=\"vfb-field-566\" class=\"vfb-control-label\">Who do you live with?<\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-566-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-566\" type=\"checkbox\" name=\"vfb-field-566[0]\" value=\"1\">Husband\/Wife<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-566-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-566\" type=\"checkbox\" name=\"vfb-field-566[1]\" value=\"1\">Common Law Spouse<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-566-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-566\" type=\"checkbox\" name=\"vfb-field-566[2]\" value=\"1\">Parent\/Guardian<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-566-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-566\" type=\"checkbox\" name=\"vfb-field-566[3]\" value=\"1\">By Myself<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-566-4\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-566\" type=\"checkbox\" name=\"vfb-field-566[4]\" value=\"1\">Other: <\/label><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-textarea\" id=\"vfbField1093\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1093\" class=\"vfb-control-label\">Their names and phone numbers:<\/label><div><textarea id=\"vfb-field-1093\" class=\"vfb-form-control\" placeholder=\"\" data-vfb-maxwords=\"32\" rows=\"3\" name=\"vfb-field-1093\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField1094\"><label for=\"vfb-field-1094\" class=\"vfb-control-label\">Have you received Nova Scotia Legal Aid before? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">Please note:  This does not include Dalhousie Legal Aid or any out of province Legal Aid.<\/span><div class=\"vfb-radio\"><label><input id=\"vfb-field-1094-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1094\" value=\"Yes (I had the same name I do now)\">Yes (I had the same name I do now)<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1094-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1094\" value=\"Yes (I had a different name at the time)\">Yes (I had a different name at the time)<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1094-2\" class=\"\" placeholder=\"\" required=\"required\" checked=\"checked\" type=\"radio\" name=\"vfb-field-1094\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField574\"><div class=\"vfb-form-group\"><label for=\"vfb-field-574\" class=\"vfb-control-label\">If you had a different name the last time you had Legal Aid, what was it?<\/label><div><input id=\"vfb-field-574\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-574\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField577\"><label for=\"vfb-field-577\" class=\"vfb-control-label\">Has your family or financial situation changed?<\/label><div><span class=\"vfb-help-block\">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.<\/span><div class=\"vfb-radio\"><label><input id=\"vfb-field-577-0\" class=\"\" placeholder=\"\" type=\"radio\" name=\"vfb-field-577\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-577-1\" class=\"\" placeholder=\"\" type=\"radio\" name=\"vfb-field-577\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-select\" id=\"vfbField1862\"><label for=\"vfb-field-1862\" class=\"vfb-control-label\">What Nova Scotia Legal Aid office did you receive help from?<\/label><div><div class=\"vfb-form-group\"><select id=\"vfb-field-1862\" class=\"vfb-form-control\" placeholder=\"\" name=\"vfb-field-1862\"><option value=\"None\" selected=\"selected\">None<\/option><option value=\"Amherst\">Amherst<\/option><option value=\"Annapolis Royal\">Annapolis Royal<\/option><option value=\"Antigonish\">Antigonish<\/option><option value=\"Bridgewater\">Bridgewater<\/option><option value=\"Dartmouth CRIMINAL LAW\">Dartmouth CRIMINAL LAW<\/option><option value=\"Dartmouth FAMILY LAW\">Dartmouth FAMILY LAW<\/option><option value=\"Halifax ADULT CRIMINAL LAW\">Halifax ADULT CRIMINAL LAW<\/option><option value=\"Halifax FAMILY LAW\">Halifax FAMILY LAW<\/option><option value=\"Halifax SOCIAL JUSTICE LAW\">Halifax SOCIAL JUSTICE LAW<\/option><option value=\"HRM Youth Office\">HRM Youth Office<\/option><option value=\"Kentville\">Kentville<\/option><option value=\"New Glasgow\">New Glasgow<\/option><option value=\"Port Hawkesbury\">Port Hawkesbury<\/option><option value=\"Sydney Conflict Office\">Sydney Conflict Office<\/option><option value=\"Sydney CRIMINAL LAW\">Sydney CRIMINAL LAW<\/option><option value=\"Sydney FAMILY LAW\">Sydney FAMILY LAW<\/option><option value=\"Truro\">Truro<\/option><option value=\"Windsor\">Windsor<\/option><option value=\"Yarmouth\">Yarmouth<\/option><\/select><span class=\"vfb-help-block\">Note: If you had a certificate lawyer, you would have seen or been referred by one of the offices below first.  <\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField576\"><div class=\"vfb-form-group\"><label for=\"vfb-field-576\" class=\"vfb-control-label\">When did you receive help? (Month and year is adequate).<\/label><div><input id=\"vfb-field-576\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-576\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1695\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-radio\" id=\"vfbField1670\"><label for=\"vfb-field-1670\" class=\"vfb-control-label\">I would like a copy of my application sent to me: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1670-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1670\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1670-1\" class=\"\" placeholder=\"\" required=\"required\" checked=\"checked\" type=\"radio\" name=\"vfb-field-1670\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-email\" id=\"vfbField1671\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1671\" class=\"vfb-control-label\">To what email address?<\/label><div><input id=\"vfb-field-1671\" class=\"vfb-form-control\" placeholder=\"\" type=\"email\" name=\"vfb-field-1671\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField1261\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Declaration and Contact Authorization<\/div><span class=\"vfb-help-block\"><p style=\"text-align: left; color: #ffffff; background-color: #ff0000;\"><strong>READ DECLARATION AND AUTHORIZATION CAREFULLY:<\/strong><\/p>\r\n<p style=\"text-align: left;\">By typing your name below and pressing submit:<\/p>\r\n\r\n<ul>\r\n \t<li style=\"list-style-type: none;\">\r\n<ul>\r\n \t<li>The applicant declares that information provided is true and complete.<\/li>\r\n \t<li>The applicant will provide additional information as required.<\/li>\r\n \t<li>The applicant consents to have information investigated for verification.<\/li>\r\n \t<li>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.<\/li>\r\n \t<li>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.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul><\/span><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1261\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField1311\"><label for=\"vfb-field-1311\" class=\"vfb-control-label\">I authorize Nova Scotia Legal Aid to contact me via email regarding my matter and for feedback purposes: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1311-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1311\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1311-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1311\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField1312\"><label for=\"vfb-field-1312\" class=\"vfb-control-label\">I authorize Nova Scotia Legal Aid to contact me via SMS (text message) regarding my matter and for feedback purposes: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1312-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1312\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1312-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1312\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField1281\"><label for=\"vfb-field-1281\" class=\"vfb-control-label\">I prefer that NSLA Communicate with me by: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-inline-group\"><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1281-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1281\" required=\"required\" type=\"checkbox\" name=\"vfb-field-1281[0]\" value=\"1\">Text<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1281-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1281\" type=\"checkbox\" name=\"vfb-field-1281[1]\" value=\"1\">Email<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1281-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1281\" type=\"checkbox\" name=\"vfb-field-1281[2]\" value=\"1\">Landline<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1281-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1281\" type=\"checkbox\" name=\"vfb-field-1281[3]\" value=\"1\">Cell Phone<\/label><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField1306\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1306\" class=\"vfb-control-label\">Signature <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-1306\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-1306\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-3 vfb-fieldType-text\" id=\"vfbField1696\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1696\" class=\"vfb-control-label\">Today's Date <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-1696\" class=\"vfb-form-control\" placeholder=\"mm\/dd\/yyyy\" required=\"required\" type=\"text\" name=\"vfb-field-1696\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-submit\" id=\"vfbField1736\"><button id=\"vfb-field-1736\" class=\" btn btn-primary\" placeholder=\"\" type=\"submit\" name=\"_vfb-submit\">Submit<\/button><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><\/form>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":6,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-15838","page","type-page","status-publish","hentry"],"aioseo_notices":[],"publishpress_future_action":{"enabled":false,"date":"2026-05-07 06:47:57","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"translation_priority","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/www.nslegalaid.ca\/fr\/wp-json\/wp\/v2\/pages\/15838","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.nslegalaid.ca\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.nslegalaid.ca\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.nslegalaid.ca\/fr\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nslegalaid.ca\/fr\/wp-json\/wp\/v2\/comments?post=15838"}],"version-history":[{"count":1,"href":"https:\/\/www.nslegalaid.ca\/fr\/wp-json\/wp\/v2\/pages\/15838\/revisions"}],"predecessor-version":[{"id":15839,"href":"https:\/\/www.nslegalaid.ca\/fr\/wp-json\/wp\/v2\/pages\/15838\/revisions\/15839"}],"wp:attachment":[{"href":"https:\/\/www.nslegalaid.ca\/fr\/wp-json\/wp\/v2\/media?parent=15838"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}