ECLC Intake Form To apply for one of our programs, please complete the intake form below. Only legal matters that are deemed urgent by ECLC will receive a call back. Thank you. First and Last Name*Town/City of Residence*Would you prefer us to contact you by phone or email?*Email* Contact Number*Is it OK to leave messages at your contact number?*YesNoBest time to call back*Gross (before taxes) monthly income (on average, includes all sources: employment income, EI, AB Works, AISH, disability income, child support, spousal support, Canada child benefit, etc.)*If you have a spouse (married or common-law), their gross (before taxes) monthly income*How many children under the age of 18, or dependents over 18 are you are financially supporting?*Have you received services from ECLC before? If yes, are you returning about the same matter?If this is a Family Law matter, have you called Legal Aid?*Please describe what your legal problem is. Include any hearings or court dates coming up.*CAPTCHA(Archived Question) How many people are in your household?*CommentsThis field is for validation purposes and should be left unchanged.