Access to Bankruptcy Court Application for Assistance
Have you ever applied for assistance with Access to Bankruptcy Court before?
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What is your First Name?
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Please provide the LAST FOUR of your Social Security Number
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What is your email address?
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Have you ever filed Bankruptcy Before
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Have you ever filed Bankruptcy Before
How much total gross income (before taxes) does your household receive each month? **This is the most important question on this form. We need the total of your gross monthly income before taxes and other deductions. This total should include social security income, food assistance, child support, wages, pension, unemployment, side job income, help from family and friends, rental income, adoption subsidies, help from roommates, and income from any businesses.
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How many minor children live with you?
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Please list the TOTAL number of people who live in your home, including yourself. This number should include everyone that lives in your home who you support. Include yourself, spouse or significant other, children, elderly relatives, and disabled persons.
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Which option best describes where you live?
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Most of our volunteer attorneys meet with clients and conduct all business virtually. Please note your preference below. Please note that it is not guaranteed your preference can be accommodated.
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If you selected that you prefer in person appointments, please select the location most convenient for you. Again, it is not guaranteed that we will be able to accommodate this request.
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Do you wish to request a specific ABC attorney?
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How did you hear about Access to Bankruptcy Court?
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Do any of the following apply to you? Please check all that apply.
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Do any of the following apply to you? Please check all that apply.
Please tell us, in your own words, why you want to file bankruptcy. Please also tell us anything else you think we should know when considering your application.
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