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Home
About
Vision & Mission
WEN Leadership
Patrons
Board of Directors
WEN Board of Advisors
WEN Board of Advisors (Royals)
WEN Board of Advisors (Non-Royals)
Executive Directors
Continental Directors
WEN Empowerment Groups
Start a WEN Chapter
Program Areas
Govt Relations
Civic Duties Activities
Judicial Education
Govt Relations Workshops
Customary Law
Common Law
Voter Education | Registration Drives
VITA ASSISTANCE APPLICATION
Culture Competency Advocacy Mediation MAP
Prevention & Diversion
Supportive Intermediary Restorative Practice
Cultural Heritage Education
Govt. Rel. Services
cCAMP – Network of Legal Expert
Legal Referral Service
Interpreter Services
General & Welfare Assistance
Crises Assistance Application
FITT-IN – Relocation Assistance
Immigration
Government Relations
Family Life & Community
Age Grade
Relationship Management
Men/Women In Family & Community
Parenting
Ageing
Welfare Assistance
Health
Culinary Traditions
Care Package
Ethnic/Culture Advocacy
Health Workshops
Mental Health
Education
CompTIA Authorized Academy Partner
GEDworks
Mentoring
Scholarships
WEN Book Club
WEN Creative Writing
WEN Magazine
Economic Resource & Development
Economic Resource & Development
Resume Building Workshop
Solar Powered Hydroponics System
International Relations
WEN Annual Ethnic Folklore Festival
Chieftaincy Title
Ethnic Studies Experts
Roots LinkUp Tour
History Workshops
Arts and Crafts
Science & Technology
Peace Making & Keeping
WERC PARTICIPANTS
WERC Participation Invitation
Recreation
WEN BASKETBALL LEAGUE OF TEAMS
WEN DB OF VERIFIED ATHLETES
Tours
Engage
Volunteer With WEN
Start a WEN Chapter
Affiliate With WEN
AFFILIATE PROJECTS
Incubate Your Project
Internship & Fellowship
Internship
Fellowship
Ethnic Studies Experts
Project Collaborators
Research & Development
Events | Workshop | Conference
Talenthon
workshops
Conferences
Festivals
Scholarships
WEN Book Club
Careers
Contact
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Family & Community Support
Intake Form-Divorce
WEN LEGAL REFERRAL INTAKE FORM
DIVORCE
Please enable JavaScript in your browser to complete this form.
Client Information
Name
*
First
Last
Email
*
Phone
*
Age
Address
*
Address Line 1
Address Line 2
City
— Select state —
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Emergency Contant – Who may we contact if we cannot get a hold of you?
Name
*
First
Last
Address (copy)
*
Address Line 1
Address Line 2
City
— Select state —
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Opposing Party's Information
Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
— Select state —
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Education
What is Your Educational Background?
*
High School
Associate
Bachelors
Masters
Doctorate
Other
What is the Educational Background of the Opposing Party?
*
High School
Associate
Bachelors
Masters
Doctorate
Other
Employment
Are You Employed?
*
Yes
No
What Kind of Job Do You?
*
Is the Opposing Party Employed?
*
Yes
No
What Kind of Job Does the Opposing Party Do?
*
How Does the Opposing Party Earn a Living to Support Him or Herself?
*
Marital Status
What Kind of Marriage Ceremony Did You Have?
*
Church
Traditional
Court
Never Married
What Date Did You Get Married?
*
Date
Time
Where Did You Get Married?
*
How Long Did You Live Together?
*
Children's Information
How Many Children Do You Have together?
*
Has Paternity Been Established?
*
Yes
No
N/A
What Ages Are Your Children?
*
Is child support currently being paid?
*
Yes
No
N/A
Who Pays Child Support?
*
I
Opposing Party
None of the Above
How Much Child Support is Paid Each Month?
*
Is the opposing Party Currently Behind in Child Support?
*
Yes
No
How Much Is the Arrearage?
*
Who carries medical/dental insurance on child(ren)?
*
What Type of Custody Do You Have?
*
Joint Legal
Soul/Full
Other
N/A
What Type of Visition is Established?
*
Visitation
Supervised Visitation
N/A
Is/Are Your Child(ren) Aware of The Opposing Party's Actions?
*
Yes
No
N/A
How Do They Feel?
*
Social Support System
Social support system refers to a network of people (formal or informal) – that deliberately reinforces enduring and noble principles, philosophies, and practices (See WEN mission – www.worldebonynetwork.com) that single parents can turn to for emotional, practical, economical, etc., Support. Individuals from such social support networks are willing to invest and sustain their resources i.e., time, money, etc., without feeling regrets, passing judgments, engaging in gossips, to achieve the expected goal(s).
Do You Belong To Any of These Social Support Group?
*
Cultural Association
Church
Peer
Other
Have You Notified The Group You Selected of This Matter?
*
Yes
No
Which One of These Support Groups Have Shown Concern?
*
How Has the Support Group Assisted You in Dealing With This Matter?
*
Are You Satisfied With the Role They've Played in Rectifying Your Situation?
*
Yes
No
Have Your Friends and Family Shown Their Support in This Matter?
*
Yes
No
Which Ones Showed Their Support (check one or two boxes)?
*
Family
Friends
What Role Have They Played?
*
Financial Support
Emotional Support
Other
If Other, Specify
*
Are You Satisfied With the Role They've Played in Rectifying Your Situation?
*
Yes
No
Is This Case Hindering You From Carrying on Your Daily Activities?
*
Yes
No
In What Way(s) is This Case Hindering You
*
What Did You or Plan to Do About It?
*
Additional Information About Your Case
Why Are You Looking For a Lawyer?
*
Signature
*
Clear Signature
Culture Competence Advocacy & Mediation Program (cCAMP)
WEN’s legal referral services (LRS) WENLRS is under our Culture Competence Advocacy and Mediation Program (cCAMP), which is a culture based resource available to you to meaningfully manage your lawyer’s expectation and supports your lawyer, especially with culture competence based resources to handle your case. As a potential client, you are also provided with the choice of requesting this advocacy and mediation service when completing your intake form if you feel it will help you meet your lawyer’s expectations. It will also provide you the necessary peace of you mind you need to ensure the lawyer is taking certain cultural information into consideration to address your case. We find that this has been a tremondous help in the past, especially for clients of strong ethnic convictions. If you will like to use this service, please sign below. Otherwise,
I Permit WEN to Use cCAMP to Manage My's Lawyer Expectation and Support My Case
*
Yes
No
Signature
*
Clear Signature
Submit