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Application for legal assistance

Completing this application form

Important

  • You cannot save your progress and return to this form to complete later.
  • Questions marked ​ are mandatory.
  • Please ensure you have enough time to complete the form in one sitting.
  • We suggest you set aside at least 15 minutes.

Be ready to upload details about your legal issue, such as names of other people involved and recent court documents.

If you provide an email address, you will be emailed a copy of the completed form once it has been submitted.

If you need to add information to your submitted form, please email this information to client.services@legalaidact.org.au and ensure you include your full name, date of birth and date form was submitted. Alternatively, you can bring the information to our office at 2 Allsop Street Canberra.

Source of Grant
Authorisation
Are you completing this application on behalf of someone else, for their legal matter?

If yes, please provide details for the person needing legal assistance, not your own.

What authority do you have to complete this application on behalf of someone else?
Do you (the person needing legal assistance) authorise anyone else to be given access to information concerning this application upon their request?
Name and contact details
Title
Preferred method(s) of contact
Residential address
Is your postal address the same as residential?
Postal address
About you
Gender
Preferred pronoun
Do you need an interpreter?
Are you of Aboriginal or Torres Strait Islander origin?
Special assistance needs
Do you identify as living with a disability
If yes what type of disability
Do you require extra or practical help to access our services?
Are you homeless or at risk of homelessness ?
Are you a single parent?
What is your highest level of education?
Are you currently in prison or a mental health facility?
Where ?
Financial details
Are you under 18?
  • You must give us all relevant information about your financial circumstances, including any income received and assets you own. 
  • We may seek further details of both your own or a financially associated person(s) income or assets to assess your eligibility to obtain legal aid. 
  • A financially associated person may include a spouse, a partner, a child, a parent, a guardian, a trustee or other relative. 
  • We may seek a contribution from you to cover some of the costs incurred by Legal Aid ACT.
Do you have any dependent children/stepchildren?
Dependent means under 18 years of age and living with you at least 50% of the time
Number of dependants
Do you receive
Please Note: You must also read and complete the “Authority to release - Centrelink” section of this form.
$
Income, expenses and assets

Income

Are you currently employed or a business owner?
Your usual income
Please select one of the options below
$
$
Income means any money received including salary, worker’s compensation, rent, child/spouse support, pensions or benefits (for example, aged or superannuation pensions, Centrelink benefits), scholarship payments.

Expenses

$
$
$
$

Assets

Do you own or pay off the home you live in?
$
$
Do you own or pay off any other real estate in either Australia or overseas?
AUD $
AUD $
Do you own anything else of value in either Australia or overseas?
For example, estimated sale value of cars, shares, bonds, caravans, boats
AUD $
Do you have any savings in a bank in either Australia or overseas?
AUD $
Upload requirements
Declaration

By signing this form, I consent to the below:

If I am charged with a criminal offence I authorise

  1. the Office of the Director of Public Prosecutions (DPP) and/or the Police to give Legal Aid ACT information about the charges against me;
  2. Legal Aid ACT to give the DPP details of my legal representative.

I understand that

  1. Legal Aid ACT may ask the DPP, Police, or any legal representative I already have, for information to decide my legal aid application and to consider any further requests for aid.
  2. I can get a copy of any material provided by the DPP or Police related to me at any time from Legal Aid ACT.
  3. This consent is ongoing when I have an active legal aid file, but I can stop it at any time by writing to Legal Aid ACT.

I acknowledge it is an offence to:

  1. Make a false or misleading statement when applying for Legal Assistance.
  2. Give a false or misleading document when applying for Legal Assistance.
  3. Refuse to give information requested by Legal Aid ACT with the intent to deceive or mislead Legal Aid ACT.

I understand that Legal Aid ACT is required to manage documents in line with the Legal Aid Act 1977, Territory Records Act 2002, Information Privacy Act 2014, and the Freedom of Information Act 2015.

Legal Aid ACT’s Information Privacy and Conflict of Interest Statement 
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