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Legal Services Request Form
Contact Information
The Legal Services Department provides trauma-informed and client-centered holistic services, including consultations, representation, legal advocacy, and safety planning to members of the LGBTQI+ communities. Our focus is on serving transgender, non-binary, and intersex adults, immigrants at risk of deportation, and youth and seniors at risk of homelessness.
Our clients are predominantly BIPOC survivors of violence and discrimination, including domestic violence, sexual assault, stalking, human trafficking, hate crimes/incidents, and police/government misconduct.
We have three interrelated projects: Community Legal Clinics, Immigration Law Project, and Homeless Youth and Housing Rights Project. At the center of our work is Survivor Services, with which all our projects work closely. This includes the Legal Advocacy Project for Survivors/Anti-Violence Project.
All clients are served at multiple locations, including the Trans Wellness Center in Koreatown, Mi Centro in Boyle Heights, Center South in Leimert Park, and the Village and the Youth Center—across from each other in Hollywood.
Confidentiality Disclosure: Your privacy matters to us. All information provided in this electronic legal intake form is strictly confidential and will only be accessed by authorized personnel for the purpose of assessing and addressing your legal needs. We adhere to strict confidentiality standards and will not disclose any information without your explicit consent, except as required by law. By submitting this form, you acknowledge and agree to the terms of our confidentiality policy.
First Name
(Required)
Please indicate what you would like to be called
Last Name
(Required)
Legal Name (if different from above)
Date of Birth
(Required)
Year
Year
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Phone Number
(Required)
Is it safe to leave a voicemail stating we are calling from the LA LGBT Center?
(Required)
Yes
No
Other
Please explain your answer for whether it's safe to leave a voicemail stating we are calling from the LA LGBT Center
Please explain your answer for whether it’s safe to leave a voicemail stating we are calling from the LA LGBT Center:
Is it safe to leave a voicemail or send an email without others being able to access it?
(Required)
Yes
No
Best Time to Contact You
Please tell us the best days and times to contact you:
Email
Address
Street Address
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Postal Code
West Hollywood Information
Do you live in West Hollywood?
(Required)
Yes
No
Where do you live in West Hollywood?
Street Address
ZIP Code
Do you work in West Hollywood?
(Required)
Yes
No
Where do you work in West Hollywood?
Employer
Street Address
ZIP Code
Do you own property in West Hollywood?
(Required)
Yes
No
Where do you own property in West Hollywood?
Street Address
ZIP Code
Do you attend school in West Hollywood?
(Required)
Yes
No
School Name
Do you spend time homeless in West Hollywood?
(Required)
Yes
No
Where do you spend time homeless in West Hollywood?
Street Address
Location Description
ZIP Code
Nature of Inquiry
Please tell us why you reached out.
Reasons for Contacting Legal Services
(Required)
Immigration Legal Services
Homeless Youth & Housing Rights
Anti-LGBTQI+ Hate Violence, Harassment, and Discrimination
DV / Intimate Partner Violence, Sexual Assault, Stalking, and Human Trafficking
Legal Clinic & Lawyer Referral Service
Change Name and Gender Marker on Identification Documents
Other
If "Other", please explain:
Please tell us the nature of the legal issue:
Do you currently receive services from the Center?
(Required)
Yes
No
If "Yes", which of our locations do you visit?
Mi Centro (Boyle Heights)
Trans Wellness Center (Korea Town)
Center South (South LA)
Youth Center (Hollywood)
The Village (Hollywood)
McDonald Wright (Hollywood)
Triangle Square
Senior Center (Hollywood)
Other
If "Other", please descibe the location
Request for Immigration Assistance
The Los Angeles LGBT Center’s Immigration Law Project provides legal consultations, court representation, including for asylum/refugee law, and holistic support to protect members of the LGBTQ+ community fleeing persecution and torture in their countries of origin. Please provide the follow information:
What sort of assistance are you seeking?
Legal Consultations and Eligibility Screenings
Application Preparation for asylum, withholding or removal, or protection under the Convention Against Torture
Applying for and renewing employment authorization (work permit)
Representation before the Immigration Court and USCIS
Removal Defense
Other
If "Other", please explain:
If “Other”, please explain:
Can you confirm your current immigration status?
U.S. Citizen
Undocumented
In Removal Proceedings (currently)
Paroled Entry
Conditional Admission; Entry with Visa (Tourist, Student, Employment)
Other Status
Please explain your immigration status:
Please explain your immigration status:
Have you already retained an immigration attorney?
Yes
No
Other
Please explain whether you've retained an immigration attorney:
Please explain whether you’ve retained an immigration attorney:
Do you have an upcoming deadline or court hearing before an immigration judge?
Yes
No
If "Yes" to the above, please provide the date of your deadline or court date.
Year
Year
2026
2025
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2023
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When was the last date you entered the United States?
Year
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Have you ever been arrested or convicted of a crime in any country?
Yes
No
Other
Please explain whether you've been arrested or convicted of a crime in any country?
Please explain whether you’ve been arrested or convicted of a crime in any country:
Have you ever been a victim of a crime in the United States?
Yes
No
Other
Please explain whether you've been the victim of a crime in the United States:
Please explain whether you’ve been the victim of a crime in the United States:
Country of Citizenship
United States
Canada
Mexico
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Homeless Youth & Housing Rights
The Los Angeles LGBT Center provides legal consultations, advocacy, preparation of documents, and court representation to promote housing stability and to prevent homelessness.
Our
Homeless Youth Project
represents youth between the ages of 18 and 24 who are at risk of homelessness or who are experiencing homelessness, while our
Housing Rights Project
provides direct legal services and advocacy to low-income individuals and families at risk of homelessness—with a focus on people 55 and older.
Are you a youth between the ages of 18-24 or person 55 and older?
Yes, Youth (18-24)
Yes, Senior (55 and older)
No
Were you referred by a homeless service provider?
Yes
No
Please confirm which homeless service provider referred you.
What sort of assistance are you seeking?
Eviction and/or unlawful detainer
Eligibility issues for subsidized housing
Reasonable accommodation requests
Public benefits
Criminal record clearing
Petitions for restraining orders
Other
Please explain what other assistance you are seeking:
Please explain what other assistance you are seeking:
Anti-LGBTQI+ Hate Violence, Harassment, and Discrimination
If You’ve Been the Victim of a Hate Crime or Incident:
Please take appropriate steps to protect yourself. First; If you’re injured, seek medical assistance. Second; make detailed notes, including witness information and any hateful words used. Third; Document location, injuries, and property damage with photographs. Fourth; please call us for assistance and support.
Our Anti-Violence Project provides comprehensive and holistic services for survivors of violence, hate crimes, harassment, discrimination, and law enforcement misconduct.
Have you been a victim/survivor of the following?
Hate Crime / Incident
Harassment
Discrimination
Law Enforcement Misconduct
Other
If "Other", please explain:
If “Other”, please explain:
Was the incident caused by an Individual or Company / Organization / Institution?
Individual
Company / Organization / Institution
Please provide the name of the Individual
We will not contact the opposing party nor any other party. All information provided is completely confidential.
If available, please provide the date of birth of the Individual
Year
Year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
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Please provide the name of the Company / Organization / Institution
We will not contact the opposing party nor any other party. All information provided is completely confidential.
If available, please provide the address of the Company / Organization / Institution
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
DV / Intimate Partner Violence, Sexual Assault, Stalking, and Human Trafficking
Our Legal Advocacy Project for Survivors provides LGBTQ+-specific, trauma-informed, direct legal services and advocacy for LGBTQ+ victims of domestic/intimate partner/dating violence, sexual assault, stalking, trafficking, and/or other crime victimization.
If you are in immediate danger, please call 911. You may also reach out to the National Domestic Violence Hotline: (800) 799-7233 or Text START to 88788
Have you been a victim/survivor of the following?
Domestic / Intimate Partner / Dating Violence
Sexual Assault
Stalking
Trafficking
Other
If "Other", please explain:
If “Other”, please explain:
Was the incident caused by an Individual or Company / Organization / Institution?
Individual
Company / Organization / Institution
Please provide the name of the Individual
We will not contact the opposing party nor any other party. All information provided is completely confidential.
If available, please provide the date of birth of the Individual
Year
Year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
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1967
1966
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1961
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1952
1951
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1949
1948
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1945
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1936
1935
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1932
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1928
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1925
1924
1923
1922
1921
1920
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Month
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12
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Please provide the name of the Company / Organization / Institution
We will not contact the opposing party nor any other party. All information provided is completely confidential.
If available, please provide the address of the Company / Organization / Institution
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Legal Clinic & Lawyer Referral
The Los Angeles LGBT Center provides free and confidential legal consultations with experienced volunteer attorneys.
We also offer a Lawyer Referral Service. If you can’t afford to pay for an attorney, our State Bar-certified Lawyer Referral Service can provide you with a consultation and direct representation. There is a $25 fee to access this service.
Please tell us what area of law you are seeking?
Bankruptcy
Business Law
Civil Rights
Consumer Law
Education
Employment Law
General Civil
Government Benefits
Housing and Landlord/Tenant
Personal Injury
Immigration
Family Law
Other
If "Other", please explain:
If “Other”, please explain:
Are you interested in a consultation or Lawyer Referral?
Consultation
Lawyer Referral
Other
If "Other", please explain:
If “Other”, please explain:
Change Name and Gender Marker on Identification Documents
Please indicate which documents you are seeking to change? Check all that apply:
Court-Ordered Name and/or Gender Change
Birth Certificate
Driver’s License
Social Security
Passport
Other
If "Other", please explain:
If “Other”, please explain:
Have you already changed any of your documents?
Yes
No
If "Yes", which documents have you already changed?
Personal Info / Demographics
Please tell us a little more about yourself so that we can better assist:
Ethnicity
Latinx
White
Black / African American
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
Middle Eastern
Multiracial
Decline to State
Other
Preferred Language
English
Afrikaans
Albanian
Arabic
Bulgarian
Catalan; Valencian
Chinese
Czech
Danish
Dutch
Estonian
Finnish
French (Canada)
French (France)
German
Greek, Modern
Hebrew
Hindi
Hungarian
Indonesian
Italian
Japanese
Khmer
Lithuanian
Norwegian
Polish
Portuguese
Romanian, Moldavian, Moldovan
Russian
Slovak
Slovene
Spanish
Swedish
Telugu
Thai
Turkish
Vietnamese
Other
Gender Identity
Woman
Man
Transgender Woman (MTF)
Transgender Man (FTM)
Non-binary / Genderqueer / Gender Non-conforming
Intersex
Questioning
Decline to State
Other
Pronouns
She / Her
He / Him
They / Them
Ze / Hir
Other
If "Other", please explain:
If “Other”, please explain:
Sexual Orientation
Lesbian
Gay
Bisexual
Heterosexual
Queer
Other
Decline to State
Are you a person with a disability?
Yes
No
Decline to State
Do you need accommodations?
Yes
No
Please tell us what accommodations you need:
Marital/Relationship Status
Single
Dating
Married
Divorced
Separated
Widow / Widower
Unmarried Partner
Decline to State
Income Source
Full-Time
Part-Time
None
Decline to State
Other
Income Source Other
If “Other”, please explain:
Please provide your monthly estimated income:
Please enter a number greater than or equal to
0
.
Highest Level of Education Completed
None or Did Not Complete Primary School
Completed Primary School
Some Secondary School
Completed Secondary School
Some College
Completed College
Completed Graduate School
Decline to State
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