Individual Application

Please answer the following questions so KCVLAA can determine: (1) if you have a legal or accounting problem; (2) if that problem is arts-related; and (3) if your income falls within our budget guidelines.

We have attempted to keep this application brief and uncomplicated. While we do not require information regarding your artistic activities, including your news releases, brochures, or lists of exhibits and performances, this information may assist our referral process and are welcome. All information submitted is kept confidential. When a referral is made, however, a copy of this application will be forwarded to the volunteer who agrees to handle your case. KCVLAA is not staffed to provide emergency legal or accounting assistance. Please be prepared to wait two to four weeks for your application to be processed.

KCVLAA does not charge for professional services. Once a referral has been made, however, clients are responsible for filing and other fees. KCVLAA does not ask its volunteers to litigate matters. Volunteers will, however, try to negotiate a solution on your behalf and/or advise you on the merits of resolving your dispute through mediation or in small claims court.

Contact Person

Address

Street Address Address Line 2 City State ZIP Code

Work Phone

Alternate Phone

Date of Birth*

Gender*

Race/Ethnicity*

**This information is collected for demographic purposes only and will be kept confidential and anonymous and will only be used in the aggregate.

What is your artistic discipline?

If you selected "Other" above, please enter additional details:

What is your legal or accounting problem? Please be specific. This information helps us find the volunteer best qualified to assist you.

Please provide the name and company of the adverse/other party (if any). If this party’s attorney has contacted you, please provide his/her name, firm, address and phone number.

Have you consulted an attorney or accountant about this problem? If yes, please provide his/her name, firm, address and phone number.

FINANCIAL INFORMATION: (Please note that your application for free legal/accounting services cannot be considered without the following information. Be sure to attach a copy of your most recent income tax return including Schedule C or Form 2106, if filed with your return.)

What is your adjusted gross income based on last year’s federal return? (If you are married and file a separate return, combine the adjusted income from both returns.)

How many dependents are in your household?

Do you have any special financial problems, such as:

Child Care

Education Expenses

Child Support or Alimony

Emergency Financial Obligations

Other

If you selected "Other" for financial problems, please specify:

What is your approximate income to date for the current year?

How did you hear about KCVLAA?

I understand that:

KCVLAA can neither guarantee that it will be able to refer my case to a volunteer nor that the representation will be successful. KCVLAA is merely a referral organization.
KCVLAA makes no representation as to the skill of the referral attorney/accountant.
I will be represented by the volunteer or the volunteer’s firm and not by KCVLAA.

I agree:

That in the event litigation or arbitration becomes necessary, I will not oppose my volunteer’s decision to withdraw from representation.
To include the KCVLAA logo in my brochures and other publication for two years after receiving assistance.
To promptly notify KCVLAA if I no longer need the assistance of a volunteer.

Individual Application

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