ECLC Intake Form To apply for one of our programs, please complete the intake form below. We will contact you within one to two business days. Name*Contact Number*Where are you contacting us from?*Is it OK to leave messages at your contact number?*YesNoBest time to call backEmail* How many people are in your household?*Monthly Income before Taxes*If this is a Family Law matter, have you called Legal Aid?Please describe what is your legal problem. Include any hearings or court dates coming up.CAPTCHAEmailThis field is for validation purposes and should be left unchanged.