Barnard Lawyers' Committee, proposed procedure for handling cases, 1971, page 2

          NAME OF CLIENT

ADDRESS

 

c .‘—.,g1.v,,,,...

REFERRED BY

S A M P L E I N T A K E F O R M
DATE

INTAKE WORKER

ZIPCODE
PHONE NUMBER - HOME WORK
HOW MUCH

? [:CAN THE CLIENT AFFORD TO PAY A FEE

COMPLAINT

ACTION TAKEN

RESOLUTION