Application for Member Legal Assistance Program

The information on this form is required in order to determine if we can assist you. Completion of this form does not guarantee assistance. Member Legal Assistance is only authorized to assist enrolled Members with limited issues and will only provide assistance in preparing documents for filing. Member Legal Assistance will not represent you as legal counsel and will not attend court dates with you or provide any other legal services beyond preparing filings.

The legal issue must arise and must be able to be resolved within either the courts of the State of Oklahoma or the courts of the Choctaw Nation.

Name(Required)
Address(Required)
Birth date
I have lived in Oklahoma for the past 6 months(Required)
I have lived in Choctaw jurisdiction for the last 90 days(Required)
Member Number: Must be an enrolled member with the Choctaw Nation to qualify for assistance. Member number is located in lower left corner of Membership card.
What do you need legal assistance with?
This is an application for legal assistance and does not guarantee you will qualify for services

Opposing Party's Information

Name
I affirm that I have read this form in its entirety and that the information provided above is accurate and complete to the best of my knowledge. I understand that providing false or misleading information may result in refusal or termination of services and could result in criminal prosecution. If you qualify for assistance, you will be contacted by program staff.
Date