I hereby affirm that the above information is correct and to the best of my knowledge, complete. This questionnaire fully and accurately describes the problem for which I am requesting legal assistance. I understand that VLA cannot guarantee that it will be able to refer my case to a volunteer or the successful resolution of the legal problem. I agree to promptly notify VLA if I no longer need the assistance of a volunteer. Should my financial situation change to make me ineligible for the services of a legal volunteer, I shall also inform VLA. I acknowledge that I have read and agree to the procedures and eligibility requirements stated in the VLA Policy Manual and/or Referral Guidelines attached to this application. I hereby agree that in the event litigation, arbitration or a similar proceeding becomes necessary, I will not oppose my current Volunteer’s decision (or formal motion before a tribunal) to withdraw from representation.
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