Allegany Law Foundation

13 Canal Street
Suite 407
Cumberland, MD 21502
301-722-3390
info@alleganylaw.com

Online InTake

Please complete the form below with your personal and legal details. All fields must be completed.
Please note, Allegany Law Foundation does NOT handle Criminal Cases.

After you hit the submit button, an Allegany Law Foundation representative will call you to complete the screening process to determine if you are eligible for services.

Step 1 Personal Information

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Note: Please use your most reliable / most used email address.

Step 2 Legal Matter

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Please read the agreement below, confirm that you have read and understand the agreement and enter your name to electronically sign the agreement.

ALLEGANY LAW FOUNDATION, INC. TERMS AND CONDITIONS

I understand that Allegany Law Foundation, Inc. (ALF) is a volunteer referral program and does not guarantee it will find an attorney who will accept my case.

You are not an ALF client until ALF notifies you that your case has been accepted. There is no attorney-client relationship with any ALF staff or volunteer attorney until you and your attorney have signed a representation agreement.

I understand that after my attorney accepts my case, my relationship with my attorney will be governed by the agreement between myself and my attorney.

I understand that once ALF refers me to an attorney, the attorney may refuse to accept my case if my case is deemed to have no merit; accepting my case would involve violation of law or Rules of Professional Responsibility; I am not prepared or able to pay the court costs or other expenses necessary for proper handling of my case; or any other legitimate reason. I understand that failure to keep appointments or failure to cooperate with the attorney or staff at Allegany Law can result in services being discontinued and I may be ineligible for services in the future.

I understand that ALF will seek to place my case with an attorney who will not charge me for representation, and that my attorney will seek waivers of fees and court costs for which I am eligible. I further understand that I am responsible for the payment of any and all non-waivable court costs, advertising fees, paternity tests, or other fees that may arise in association with my case.

I authorize ALF to share any and all of my personal and financial records with my assigned attorney, law office staff, or legal or social service agencies to whom my matter is referred by ALF. I authorize my attorney to disclose to ALF any information that my attorney learns about my financial circumstances.

I hereby permit and instruct any attorney, law office staff, legal or social services agency to which this matter is referred by ALF to respond by phone or in writing to requests made by ALF for information about the facts, progress or outcome of my case.

I understand that ALF may check the accuracy of the information I have provided about my household, assets, and income.

If my financial circumstances improve during the time I am represented by an attorney, I will immediately inform ALF and my file will be reviewed for continued services. If I do not qualify based on eligibility criteria, I agree to negotiate a private fee with the attorney for continued representation.

I understand that ALF may close my case at any time upon learning that the information provided is incorrect.

I authorize ALF to release the information provided during the application and intake process to persons checking to see that ALF has complied with the restriction on its funding.

I release Allegany Law Foundation, Inc. and its officers, directors, members, and employees from any and all claims, losses, and liability arising out of any referral made by or through any of Allegany Law Foundation’s programs.

I authorize ALF to contact me through all communication outlets, including but not limited to mail, phone, email and text, unless I notify ALF that I do not want to receive that communication type and I agree to keep ALF informed of any changes to my contact information

If you are not satisfied with the services you receive, you may contact the Executive Director by telephone or in writing. The Executive Director will attempt to resolve the matter. If the matter is not resolved you may address a request for review in writing to the Executive Committee of the Board of the Directors, who will attempt to resolve your matter.

I certify that the information I have provided to Allegany Law Foundation, Inc. is true and exact to the best of my knowledge. I certify that I have read and agree with the terms and conditions stated above. Further, I understand if it is discovered that I have falsified this document, I may become ineligible for attorney placement with the Allegany Law Foundation, Inc.

I acknowledge that I am submitting information for intake and that additional documents and information will be required to complete my application for services.

I hereby confirm with my electronic signature my acceptance of the agreement.


Type your name to acknowledge the agreement.
9/14/2025 12:55:16 AM