By submitting an online intake form application, you acknowledge that you understand the following:

Cancer Legal Resource Center (CLRC) is a legal resource organization that can provide information about laws that may pertain to your situation, as well as resources that may enforce your rights. However, CLRC does not provide legal advice or financial assistance, and generally does not provide direct legal representation.  Completing this intake form will provide CLRC with some necessary information regarding your situation.  After you have completed this form, it will be reviewed by a CLRC staff attorney, who may contact you for additional information.  CLRC will then contact you with appropriate resources and information by phone or mail, depending on your situation.

Any information that you provide is kept confidential.  Please keep in mind that filling out this online intake form authorizes us to use your anonymous statistical information for research purposes.  None of your personally identifying information (name, address, phone, etc.) will be disclosed to anyone outside of the CLRC.