CLC - Community Legal Center



APPLICATION	Please fill out and submit form for assistance. Name Address City State Zip Telephone # Choose one home work cell Telephone # Choose one home work cell E-mail address: Short description of problem you need help with: In order to qualify for our services, you must be within our income guidelines. To make that determination we need to know the number of people living in the house where you live. Even if you don't consider them part of your family, if they are living in your house, or you are living in theirs, please count them. Now we need to know the gross income of your household.This includes all income of every person living there, whether it's taxable or not. Gross is before they withhold anything. It's not what you take home. If you are employed your paycheck stub should have the gross income listed.Income (for CLC purposes) includes wages, self-employment income, disability, child support, AFDC, Food stamps, unemployment, social security, rental income, etc. You can use either monthly, annually or other to state your income: $ Monthly annually $ other If other pay period, tell what the period is: We will either e-mail you back or call you back after we receive your form. If you would prefer to call us, rather than using this form, our number is 543-3395
Commmunity Legal Center \| 910 Vance Memphis, TN 38126 \| Voice 901.543.3395 Fax 901.543.0907 \| Email info@clcmemphis.org ©2005 clcmemphis.org All rights reserved.