Application foR appeal or amicus brief

Please note: The DV LEAP Offices will be closed on January 18th for MLK Day and January 20th for the Presidential Inauguration. There may be a slight delay in our application review process at this time.
Our Legal Team will get back to you as soon as possible in regards to your application.

Thank you for your patience.

Please note: Before you complete this application, please confirm that the deadline to file your Notice of Appeal has not passed. Unfortunately, DV LEAP cannot help you if this deadline has passed.

A. Applicant Information

Full Legal Name (First Middle Last): *

Preferred Name (First Middle Last):

how would you like to be addressed in
(example: jane, jane doe, Mr. Doe,
Miss. Doe)

Date of Birth: *

Gender/Gender Identity:

(Please note: This question is optional but must be asked for grant
reporting purposes.)

Sexual Orientation:

(Please note: This question is optional but must be asked for grant
reporting purposes.)

Your Pronouns:*


Did Another organization refer you to Dv leap?*

(If yes, please put the name of the organization here.
If no, please write N/A.)

Email Address:*

(Please make sure your email is correct as our initial
communication regarding this application will be by email.)

Is it safe to email?*

Phone Number: (Including area code)*

Is it safe to call?*

Is it safe to leave a message?*

Current Mailing Address:*




Is It Safe to Receive Mail Here?*

Are You Registered in the "Safe AT Home" Program?

Do You Identify as Having a Disability?

If Yes, is there Anything DV LEAP Should Know
or do to Best Serve you and your needs?

In what language are you most comfortable Communicating?*

Are there any other languages you use?

do you have a fee waiver in your case?*

please select the average number of people living in your household over the past 12 months, and indicate whether your annual gross (before taxes) income was above or below the corresponding amount listed below.*

For grant reporting purposes, DV LEAP asks about income. This information is required but will NOT affect your eligibility for our services.

B. Type of assistance

is the order you are seeking to
appeal a final order?

Please note: DV LEAP only assists with appeals of final orders, not temporary orders.

what kind of assistance are you seeking?

A. Are you seeking representation to appeal this order?

B. Has someone filed an appeal against you, and you
are seeking representation?

 C. Are you seeking an amicus brief for your appeal?

C. information about the case

state case is located in:*

COunty The Case is located in:*

Case number:

type of case:*

Date of final order: *

do you have a physical copy of the final order?*

how many days was your trial/hearing that
resulted in this final order?

Do you have written transcripts from your trial?*

if you are seeking an appeal, what are the grounds
for your appeal and/or what errors do you
believe the court made?

(200 word limit)

if you are seeking an amicus brief, how will the
brief help your appeal and/or what issues do you
want it to address?

(200 word limit)


If yes, What date did you file the notice of appeal?

is there another hearing scheduled in this case [or a related case]?*

If yes, what is the date of the next hearing?

If yes, what is this next hearing about? (100 word limit)

D. Information about your legal representation

Did a lawyer represent you at the trial resulting in the order you want to appeal/ is being appealed against you?*

Is this lawyer still representing you?*

Lawyer's name:

Lawyer's firm/organization:

Lawyer's email address:

lawyer's phone number:

(Including area code)

Do you give DV LEAP permission to contact your
lawyer to discuss your case?

Do you have a lawyer representing you in your appeal?*

e. Information about your opposing party

opposing party's Name (First Middle Last): *

opposing party's date of birth:*

Did your opposing party have a lawyer representing them in the order you want to appeal/ is being appealed against you?*

opposing lawyer's name:

opposing lawyer's firm/organization

F. Information about DOMESTIC VIOLENCE
(Domestic violence can occur between two people who have or have had an intimate relationship or have a child in common or are closely related. Domestic violence can be physical, emotional, sexual or financial. It can happen once or more than once. It can happen recently or a long time ago. We understand that answering these questions may be difficult and thank you for responding.)


Did the opposing party in your case commit domestic violence against you and/or your child(ren)?*

if yes, please describe:

(Optional) - (150 words):

Did a court find that your opposing party committed domestic violence against you And/or your child(ren)?*

We understand that some people who were abused have had protection orders or findings of abuse issued against them. Has the opposing party accused you of domestic violence?*

Did a court find that you committed domestic violence?*

G. other questions

Is there any other information about your case or your situation that you want to share with us?

(150 words):

Is there anything we need to know about your culture or community that would help us understand your situation?

(150 words):

Thank you! Your submission has been received!

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