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HIV/AIDS Legal Services Screening Form

 

 

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This Program provides legal assistance to low-income San Diego County residents living with HIV/AIDS. Regardless of whether you become a client of the San Diego Volunteer Lawyer Program (SDVLP), the information you provide on this form is kept strictly confidential.

IMPORTANT: FIELDS MARKED WITH A * ARE REQUIRED FIELDS. IF YOU DO NOT COMPLETE ALL OF THE REQUIRED FIELDS, THE FORM WILL NOT SUBMIT. THE FIELDS WITH ERRORS WILL BE HIGHLIGHTED IN RED.

This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under H89HA00001, HIV Emergency Relief Project Grants for a contracted amount with the County of San Diego. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, the U.S. Government or the County of San Diego.

Have you been diagnosed with HIV/AIDS?*

This Project is funded to assist people living with HIV/AIDS. If you do not have HIV/AIDS but need legal assistance, please call SDVLP's main desk at (619) 235-5656, Ext. 100, for further assistance.

This application may take 15-30 minutes. Please have ready information about your income & assets, the income & assets of other people in your household, and your legal matter (including your court case number, if you have one).