Apply for Service

You must qualify financially and live in South Etobicoke to receive our services. We can only help you if you are living on a low income.

We can provide legal advice or representation for:

• Tenant’s Rights and Housing Issues
• Social Assistance Issues
• Employment Issues
• Immigration Issues

Please complete this form as fully as possible. It may take up to three business days for a member of our staff to follow up with you.

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Personal Information

Name *

First

Last

Date of Birth *

Email *

Phone *

Gender Identity *Please selectMaleFemaleOther

Other – please specify

PronounsPlease selectHe/himShe/herThey/themOther

Other – please specify

Are you seeking to receive legal assistance together with any other person(s) (family, friend, roommate, etc.) regarding the same legal issue? If so, please provide their name(s), address and date(s) of birth and any additional contact information for them

Address

If you are at no current fixed address, please enter the closest intersection to your current location.

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code *

Postal Code

You may have entered an incomplete postal code or one that is outside our service area. To identify the clinic that serves your community, visit https://www.legalaid.on.ca/legal-clinics/. If you believe that your address has been mistakenly excluded from our service area, please submit this completed form and contact us at 416-252-7218.

Income

We can only help people with low incomes. However, if your income is too high, we may still be able to provide you with summary advice and discuss referral options.

What is your main source of family income? *

• Employment
• Ontario Works (OW)
• Disability Support Program (ODSP)
• Canada Pension Plan (CPP)
• Old Age Security (OAS) plus Guaranteed Income Supplement (GIS)
• War Veterans Allowance
• Workers’ compensation benefits that are temporary or threatened
• Other

Other – please specify

Number of Adults in the Family *

Number of Children *

Approximate Total Monthly Family Income (you & other family members living with you) *

Language and Accessibility

Special Needs/Accommodation Required

Language Spoken

• English
• Other

Other – please specify

Preferred Language

Interpreter Required

• Yes
• No

Area of Law

What sort of problem do you have? *

• Housing Law (eviction, repairs, harassment by landlord, rent subsidy taken away, discrimination)
• ODSP – Ontario Disability Support Program (denied, benefits cut off, overpayment)
• OW – Ontario Works (denied, benefits cut off, overpayment)
• CPP – Canada Pension Plan (retirement benefits or CPP disability benefits)
• Immigration
• Employment Law (wrongful dismissal, employment standards, EI, discrimination)
• Other

Type of property you live in? *Please selectPrivate rentalCondominiumRent-subsidized unitCo-op

Your move in date? *

Do you have a lease? *Please selectYesNo

Do you share a kitchen or bathroom with your landlord? *Please selectYesNo

Landlord’s name? *

Have you received any forms? If yes, what?

Date you received form

Is there a termination date? If yes, when?

Is there a hearing date? If yes, when?

Is there a Sheriff’s Notice to Vacate date? If yes, when?

Date you applied?

Date you received a denial letter?

What was the reason for denial?

Date you requested an Internal Review or deadline for Internal Review?

Have you received and Internal Review decision? Date received?

Date you filed an appeal to the Social Benefits Tribunal or deadline for filing?

Is there a hearing date scheduled? If yes, date?

Status in CanadaPlease selectCanadian citizenPermanent residentProtected Person / Convention RefugeeRefugee claimantWork permit (temporary resident)Study permitVisitorNo StatusOther

Your employer’s company name?

Your job title?

Were you unionized? Please selectYesNo

Your start date?

Your end date?

Are you currently working?Please selectYesNo

Is there any deadline? Please selectYesNo

Details of Issue

Brief description of problem *

Please attach copies of any documents relating to the problem. For example, an eviction notice or a letter from Ontario Works.

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Statistical Information

This information does not impact whether you receive assistance from us, and is only collected to help us better understand the communities we serve.

SexualityPlease selectPrefer not to answerGay/LesbianHeterosexualBi-sexualQueerTwo SpiritedOther

Other – please specify

Ethno-racial Identification *Please selectUnknown/Choose not to identifyAboriginal/Indigenous (inside North America)Aboriginal/Indigenous (outside North America)African Ancestry – North AmericanAfrican Ancestry – CaribbeanAfrican Ancestry – Latin AmericanAfrican Ancestry – EuropeanAfrican Ancestry – Continental – North AfricaAfrican Ancestry – Continental – South AfricaAfrican Ancestry – Continental – East AfricaAfrican Ancestry – Continental – West AfricaLatin AmericanAsian – South AsianAsian – Southeast AsianAsian – West IndianAsian – FilipinoAsian – ChineseAsian – KoreanAsian – JapaneseMiddle Eastern – ArabMiddle Eastern – OtherWhite/Caucasian – North AmericanWhite/Caucasian – OtherOther or Mixed Racial Heritage: Specify

Other – please specify

Referring/Assisting Organization

The person seeking legal assistance is also working withPlease selectN/ACommunity agencyHealth care providerFamily memberOther

Other – please specify

Organization Name

Contact Name

Position

Phone

Email

Relationship to person seeking legal assistance

Checkbox

• The person/organization above has completed this form on behalf of the person seeking legal assistance.
• The person seeking legal assistance has given consent for the assisting person/organization to provide and receive information, instructions to, and advice from South Etobicoke Community Legal Services on behalf of the person seeking legal assistance.

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