You MUST complete and submit this form prior to contacting the USARLC.

Please read information about Requesting Legal Assistance before filling out the form below.

Date of Request

Name

First

Middle

Last

Gender

Status

Grade

DODID

Branch of Service

Address

Street

City

State

Country

Zip

List your current local address. This should be the address where you currently reside and the geographical area in which an attorney will be contacted.

Marital Status

Select your current marital status. If you are pending a divorce or legal separation, but the divorce or legal separation has not been approved by a judge, select married.

Spouse Name

List the full name of your spouse. If you are legally separated, you must list your spouse.

Phone Number (Primary)

Phone Number (Secondary)

Confirm

Unit of Assignment

List the unit to which you are currently assigned or attached.

Case Type

Select the type of case the best indicates your legal issue(s). If you do not see your issue on the list, select "other".

Deploying?

Yes
No

Select "Yes" if your unit or you as an individual received orders to deploy. Select "Yes" if you have not received orders, but received notice of an upcoming deployment. Otherwise, select "No".

Have you spoken with an attorney on this matter?

Yes
No

Select "Yes" if you have spoken with any attorney, military or civilian, regarding the issue(s) listed on this form. Otherwise, select "No".

Have you paid/retained this attorney?

Yes
No
N/A

Select "Yes" if you have paid money to an attorney to obtain the attorney's assistance with the issue listed on this form.

Briefly explain your legal issue:

Do you have an upcoming court date on this matter?

Yes
No

Select "Yes" if you have an upcoming date for a court hearing or trial. List the date below.

Court Date

Please describe what you would like or what you expect an attorney to do for you:

Explain the outcome you hope for or expect after receiving legal services from an attorney.

List others and/or organizations that might disagree with you on this issue. (This is usually the opposing party to the legal issue) If none, state "N/A".

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MG Benjamin Hunton Memorial Reserve Center
8791 Snouffer School Road
Gaithersburg, Maryland 20879-1624

General Inquiries: 910-598-8828
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