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2. Name*
3. Email Address*
5. Phone Number*
7. Are you already working with the Court Facilitator?*

   1. Yes
   2. No
9. If yes, please skip the following questions and type what you need assistance with in the text box below.
11. What type of case are you seeking help with?
    -- Select One --Divorce with ChildrenDivorce without ChildrenLegal SeparationParenting Plan/Child SupportMoving with ChildrenNon Parental VisitationFamily Law Restraining OrdersTemporary Family Law OrdersParentage (limited)Guardianship (limited)Minor Guardianship (limited)Review of Final Orders
13. Final Orders to be Reviewed
15. Do you receive State assistance?

    1. Yes
    2. No
16. Are you/have you been represented by an attorney?

    1. Yes
    2. No
17. Do you need an interpreter?

    1. Yes
    2. No
19. What county do you live in?
21. What county does the other party live in?
23. If children are involved, what county do they live in?
25. Do you have an existing case?

    1. Yes
    2. No
26. If yes, please list the county and state, as well as case number(s).
28. Additional Comments:
30. Once this form is received, the Court Facilitator will reach out to you by email as soon as possible. Please be sure to check your junk/spam folders. You will need to follow the instructions in the email in order to schedule an appointment.
32. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) you have read the disclaimer and policies above this form and would like to proceed with Court Facilitator assistance, 2) your application will not be signed in the sense of a traditional paper document, 3) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 4) you may still be required to provide a traditional signature at a later date.

    1. I agree.
34. Electronic Signature
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field