STUDENT LEGAL SERVICES
I am currently enrolled as a student at The University of Texas at Arlington and have paid the
required student service fee to utilize this service. This legal matter for which I am requesting
consultation with the Students’ Legal Advisor concerns my personal legal problems only, and is
not a problem of a relative, friend, acquaintance or another student at this university. In addition,
my legal problem is not against another student, faculty member, staff member or administrator
or department at this university.
_______________________________________________
__________________
Print Last Name
UTA ID#
First Name
________________________________________________________
_____________________
Address
Date of Birth
________________________________________________________
_____________________
City, State Zip
Telephone Number
______________________________________________________________________________________
Email Address
Marital Status:
Ethnicity:
Classification:
FR
Single
Married Widowed
Divorced
Engaged
Separated
Cohabitant
American Indian / Alaskan Native
Asian or Pacific Islander
Black (non-Hispanic)
White (non-Hispanic)
Hispanic
Other _______________
SO
JR
SR
Are you an International Student? Yes_____
Postgraduate
GR
Major:_______________
No_____
How did you hear about the Student Legal Services’ office?
Freshman Orientation___
Website___
Faculty/Staff Member___
UTA Organization___

Catalog___
Shorthorn___
Friend___
Other____________
Another Student___
In the event the current Students’ Legal Advisor leaves employment of UTA, will you permit the
delivery of this from to any subsequent Students’ Legal Advisor?
Yes
No

Have you already consulted with an attorney regarding this issue?
Yes
No

Does this matter involve another student enrolled at UTA?
Yes
No

If this office conducts a student survey, I agree to participate.
Yes
No

A survey may be mailed to my address stated above.
Yes
No

Is this your first visit to see the Students’ Legal Advisor this semester? Yes
No
Reason for consultation:
___Auto Accident
___Consumer Protection
___Landlord/Tenant
___Estate Plan
___Immigration
___Insurance
___Traffic Tickets
___Employee Rights
___Lawyer Referral
___Taxation
___Domestic Relations
___Notary
___Finances/Credit
___Criminal
___Miscellaneous
___University Problem
FORM CONTINUES ON REVERSE

Do you have documents pertaining to this problem?
Yes
No

Did you bring them for the consultation
Yes
No

In what city or county did this incident originate? ___________________________
Please write a description of your legal problem as you see it:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
What is the question you want answered during this consultation? Please state:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
DISCLAIMER:
I am currently enrolled as a student at The University of Texas at Arlington and
have paid the required student service fee to utilize this service. This legal matter
for which I am requesting consultation with the Students’ Legal Advisor concerns
my personal legal problems only, and is not a problem of a relative, friend,
acquaintance, or another student at this university. In addiction, my legal problem
is not against another student, faculty member, staff member, administrator, or
department at this university.
_____________________
__________________________
__________________
Printed Name
Signature
Date