Legal Aid Queensland application form (LAQAPP) – Application for Legal Aid in Queensland Instructions

Describe your current living arrangements (for example, moved in with a relative, moved to a nursing home, moved to a low‑set house). Fill only if '7a Moved out due to disability/health - Yes' is 'Yes'.

Enter how long you have lived in the home (for example "5 years" or "3 years 6 months"). Fill only if '7a - Yes (the home you live in) - Give details' is 'Yes'.

Provide the date when you purchased the home. Fill only if '7a - Yes (the home you live in) - Give details' is 'Yes'.

Enter the current market value of the home. Fill only if '7a - Yes (the home you live in) - Give details' is 'Yes'.

Enter the amount of equity you have in the home (market value minus any mortgage outstanding). Fill only if '7a - Yes (the home you live in) - Give details' is 'Yes'.

Enter the total outstanding mortgage balance on the home. Fill only if '7a - Yes (the home you live in) - Give details' is 'Yes'.

Check this box if you or a person who helps you financially do own or are paying off the home you live in, and you will provide the requested value, mortgage and equity details.

Check this box if you or a person who helps you financially do NOT own or are NOT paying off the home you live in.

Enter the amount of money you receive from the property you still own but have moved out of (for example rent), given as the weekly amount.

Describe the disability or health problem (including when it occurred and how it affected your housing) that caused you, as a person aged 60 or older, to move out of the home or to buy another home. Fill only if '7a Moved out due to disability/health - Yes' is 'Yes'.

Check this box if the applicant (aged 60 or older) has had to move out of the home or buy another home because of a disability or health problem.

Check this box if the applicant (aged 60 or older) has not had to move out of the home or buy another home because of a disability or health problem.

Check this box to indicate you will (or have) provide(d) full details describing the disability or health problem and how it caused the move or new home purchase.

Enter the amount of equity you have in that other property (market value minus any mortgage or loans), in dollars. Fill only if '7b Yes' is 'Yes'.

Enter the total outstanding mortgage or loan balance (in dollars) secured on that other real estate. Fill only if '7b Yes' is 'Yes'.

Enter the current market value (in dollars) of the other real estate you own apart from the home you live in. Fill only if '7b Yes' is 'Yes'.

Check this box if you (or the person who helps you financially) do own other real estate (for example, a house or land) apart from the home you live in.

Check this box if you (or the person who helps you financially) do not own any other real estate apart from the home you live in.

Check this box if you have answered Yes and need to provide further information about the other real estate (value, mortgage, equity and other details).

Enter the total equity you have in your motor vehicle(s) (market value of the vehicle(s) minus any outstanding car loan). Fill only if '7c Motor vehicle(s) — Yes' is 'Yes'.

Check this box if you do not own a motor vehicle and are not paying off one, i.e., there are no motor vehicles to declare for question 7c.

Check this box if you (or a person who helps you financially) own a motor vehicle or are paying off one and you need to declare it for question 7c.

Check this box when you have answered Yes and will provide the requested vehicle equity/details in the adjoining fields for question 7c.

Enter the total amount of money currently held in the bank account (in dollars) for you or the person who helps you financially. Fill only if '8 Money in the bank - Yes' is 'Yes'.

Check this box if you or a person who helps you financially do NOT have any money in the bank.

Check this box if you or a person who helps you financially DO have money in a bank.

Check this box when you are providing the bank account amount and additional details (for example the $ amount and attaching bank statements) about money in the bank.

Provide a clear description of any other valuable assets you (or a person who helps you financially) have that you can sell or use now, including item types, values and any relevant details.

Check this box if you (or the person who helps you financially) have any other valuable items not listed above that you can sell or use now, and you will provide details in the space provided.

Provide the total amount of superannuation you can access now, insurance payments, or any other valuable items you can sell that are available to you or the person who helps you financially.

Provide the current total value of any recreation vehicles (for example boats or caravans) that you or the person who helps you financially can sell or use now.

Provide the current total value of any shares or bonds that you, or the person who helps you financially, can sell or use now.

Provide the current total value of any other valuable assets not listed above that you or the person who helps you financially can sell or use now and give details if prompted.

Check this box if you identify as Torres Strait Islander (if you also identify as Aboriginal, tick both the Aboriginal and Torres Strait Islander boxes).

Check this box if you identify as Aboriginal (if you also identify as Torres Strait Islander, tick both the Aboriginal and Torres Strait Islander boxes).

Check this box if you do not identify as Aboriginal or Torres Strait Islander.

Provide any extra information about your family, children, relationship or dispute relevant to the form, including dates, names and brief explanations, in this large free‑text box.

Check this box if you are not the applicant and you are completing the application on behalf of another person (for example under power of attorney, a QCAT order, or as a parent/guardian).

Check this box if you are the applicant and you are completing and submitting the application on your own behalf.

Check this box if you are 17 years old or younger.

Check this box if you are older than 17 (you are not 17 years old or younger).

Enter the specific authority you hold to complete this application on someone else’s behalf (for example: power of attorney, QCAT order, parent, guardian). Fill only if 'No — I am completing this application for someone else' is 'No'.

Check this box when you are completing the application on behalf of another person (not for yourself) and will provide the authority (for example, power of attorney, QCAT order, parent or guardian).

Enter your full date of birth as it appears on your official documents.

Enter the name of the country where you were born (provide the country if you answered 'Yes' to being born in another country). Fill only if 'Yes (Born in another country)' is 'Yes'.

Check this box if you were born in a country other than the one this form is for.

Check this box if you were not born in another country (i.e., you were born in this country).

Check this box when you have answered Yes and will enter the name of the country where you were born in the adjacent field.

Enter the full name or description of the offence or charge for the fifth listed entry. Fill only if 'Q11 Yes' is 'Yes'.

Enter the date you were charged for the fifth listed offence. Fill only if 'Q11 Yes' is 'Yes'.

Enter the name or brief description of the first charge or offence being listed. Fill only if 'Q11 Yes' is 'Yes'.

Enter the date when the first listed charge was filed or the defendant was charged. Fill only if 'Q11 Yes' is 'Yes'.

Enter the name or short description of the offence for the fourth charge as listed on the charge sheet. Fill only if 'Q11 Yes' is 'Yes'.

Enter the date when the fourth charge was laid or when you were charged for this offence. Fill only if 'Q11 Yes' is 'Yes'.

Enter the date you were charged for the second offence as shown on official paperwork. Fill only if 'Q11 Yes' is 'Yes'.

Provide the full name or brief description of the second charge (the offence you were charged with). Fill only if 'Q11 Yes' is 'Yes'.

Enter the date you were charged for the third listed offence (day, month and year). Fill only if 'Q11 Yes' is 'Yes'.

Enter the full name or brief description of the offence for the third charge as it appears on the charge paperwork. Fill only if 'Q11 Yes' is 'Yes'.

Check this box when you need to provide additional details about the charges listed on this page by completing question 18.

Check this box if you have attached photocopies of any court documents you have received or filed related to this matter.

Check this box if you are attaching the Queensland Police Service Court Brief (QP9) or other documents showing criminal/traffic history, a notice to appear, or a proceeds of crime order for the criminal law problem.

Check this box if you have attached any court orders, family dispute resolution certificate(s), or an invitation to attend a family dispute resolution conference to your application.

Check this box if you have answered all relevant questions on the application, including question 18 on page 13.

Check this box if you have read and signed the 'Declaration and authority to release information' on page 14.

Check this box if you have attached a Centrelink income statement as proof of income.

Check this box if you have attached payslips for at least the last four weeks or a letter from your employer confirming your income.

Check this box if you have attached copies of bank statements from all financial institutions covering the past three months.

Check this box if you have attached documents that verify your self-employed income (for example business records, profit/loss statements or tax returns).

Check this box if you do not have any children under 18.

Check this box if you have one or more children under 18 (and then provide their details in the table shown).

Enter the given (first) name of the person who made the complaint. Fill only if 'Not sure' is 'No'.

Enter the family (last) name or surname of the person who made the complaint. Fill only if 'Not sure' is 'No'.

Check this box if you do not know or are not sure who made the complaint (i.e., you cannot provide the complainant's family or first name).

Enter the date on which the applicant or authorised person signed this consent.

Enter the full name of the applicant or authorised person who is consenting to Police Prosecutions releasing information to Legal Aid Queensland.

Provide the signature of the applicant or authorised person to confirm and authorise Police Prosecutions to give the specified information to Legal Aid Queensland.

Check this box if you do NOT consent to Police Prosecutions providing Legal Aid Queensland with a copy of your Queensland Police Service Court Brief (QP9) and/or your criminal and traffic history.

Check this box if you DO consent to Police Prosecutions providing Legal Aid Queensland with a copy of your Queensland Police Service Court Brief (QP9) and/or your criminal and traffic history.

Enter any additional contact information such as an alternative email address, secondary phone number, or other relevant contact details.

Enter the primary email address where we can contact you.

Enter the area or STD code for your work phone (for example city or country code), if applicable.

Enter the main work telephone number (the local number portion) you can be reached on.

Enter your mobile phone number where you can be contacted (include country or area code if needed).

Enter the area or STD code for your home phone (for example city or country code), if applicable.

Enter the main home telephone number (the local number portion) you can be contacted on.

Enter details of any counselling, mediation or family dispute resolution sessions with the person you are in dispute with, including dates, provider or mediator name, number of sessions, key outcomes and any certificate references or attachments. Fill only if 'Counselling/Mediation - Yes' is 'Yes'.

Check this box if you have attended counselling, mediation or family dispute resolution sessions with the person you are in dispute with (and attach any certificates received from these sessions).

Check this box if you have not attended any counselling, mediation or family dispute resolution sessions with the person you are in dispute with.

Enter the time of the scheduled court appearance or tribunal hearing. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Enter the date of the court appearance or tribunal hearing if you know it. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box when you DO have to go to court or a tribunal; if known, provide the response and hearing date/time and attach any court documents.

Check this box when you do NOT have to go to court or a tribunal in relation to this matter.

Check this box if the court you must attend is the Drug Court. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box if the court you must attend is the Mental Health Court. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box if the court you must attend is the Supreme Court. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box if the court you must attend is the Federal Circuit Court. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box if the court you must attend is the Family Court of Australia. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box if you are unsure which court or tribunal you must attend. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box if the court you must attend is the District Court. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box if you must attend a tribunal and provide the tribunal details in the adjacent 'Give details' field. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box if the court you must attend is the Childrens Court. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box if the court you must attend is the Court of Appeal. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box if the court you must attend is the Magistrates Court. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Enter the suburb or town name where the court or tribunal is located. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box if you do have a criminal record and you will either attach a copy of your criminal record or list your criminal record (including matters where no conviction was recorded). Fill only if 'Yes — I have a criminal record', 'Not sure — I am unsure if I have a criminal record' is 'Yes' or is 'Not sure' (any).

Check this box if you have a criminal record and will attach a copy or list your criminal record, including matters where no conviction was recorded.

Check this box if you are unsure whether you have a criminal record and cannot confirm yes or no at this time.

Check this box if you do not have a criminal record and have no relevant matters to attach or list.

Provide the name or short description of the offence for the first listed criminal record entry. Fill only if 'Yes — I have a criminal record', 'Not sure — I am unsure if I have a criminal record' is 'Yes' or is 'Not sure' (any).

Describe the penalty or outcome for the first listed offence (for example: fine, community service, probation, sentence). Fill only if 'Yes — I have a criminal record', 'Not sure — I am unsure if I have a criminal record' is 'Yes' or is 'Not sure' (any).

Enter the year when the offence occurred for the first listed criminal record entry (e.g. 2020). Fill only if 'Yes — I have a criminal record', 'Not sure — I am unsure if I have a criminal record' is 'Yes' or is 'Not sure' (any).

Provide a short description or name of the offence for the fourth criminal-record entry. Fill only if 'Yes — I have a criminal record', 'Not sure — I am unsure if I have a criminal record' is 'Yes' or is 'Not sure' (any).

Enter the penalty, sentence or outcome (for example fine, community service, conviction) related to the fourth offence. Fill only if 'Yes — I have a criminal record', 'Not sure — I am unsure if I have a criminal record' is 'Yes' or is 'Not sure' (any).

Enter the year when the offence occurred for the fourth criminal-record entry. Fill only if 'Yes — I have a criminal record', 'Not sure — I am unsure if I have a criminal record' is 'Yes' or is 'Not sure' (any).

Describe the offence or charge for the second criminal record entry (e.g., the name or brief description of the offence). Fill only if 'Yes — I have a criminal record', 'Not sure — I am unsure if I have a criminal record' is 'Yes' or is 'Not sure' (any).

Provide the penalty, sentence or outcome imposed for the offence listed in the second criminal record entry. Fill only if 'Yes — I have a criminal record', 'Not sure — I am unsure if I have a criminal record' is 'Yes' or is 'Not sure' (any).

Enter the year when the listed offence occurred for the second criminal record entry. Fill only if 'Yes — I have a criminal record', 'Not sure — I am unsure if I have a criminal record' is 'Yes' or is 'Not sure' (any).

Provide a brief description or name of the offence for the third criminal record entry. Fill only if 'Yes — I have a criminal record', 'Not sure — I am unsure if I have a criminal record' is 'Yes' or is 'Not sure' (any).

Enter the penalty, sentence or outcome given for the offence listed in the third criminal record entry. Fill only if 'Yes — I have a criminal record', 'Not sure — I am unsure if I have a criminal record' is 'Yes' or is 'Not sure' (any).

Enter the year when the offence occurred (four-digit year) for the third criminal record entry. Fill only if 'Yes — I have a criminal record', 'Not sure — I am unsure if I have a criminal record' is 'Yes' or is 'Not sure' (any).

Enter the date when your de facto relationship with the person ended or when you separated from them. Fill only if 'Defacto relationship - Yes' is 'Yes'.

Enter the date when your de facto relationship with the person began. Fill only if 'Defacto relationship - Yes' is 'Yes'.

Check this box if you were NOT in a de facto relationship with the person you are in dispute with.

Check this box if you WERE in a de facto relationship with the person you are in dispute with.

Check this box if you need to provide the relationship and separation dates or other details about the de facto relationship.

Enter the specific disability type(s) and a short description of how each affects your ability to access services (e.g., intellectual, psychological/psychiatric, sensory, physical and the particular access needs). Fill only if 'Physical' is 'Yes'.

Check this box if you DO have a disability that affects how you access our services.

If you answered Yes, check this box if you have a sensory disability (including speech) that affects how you access our services.

If you answered Yes, check this box if you have a psychological or psychiatric condition that affects how you access our services.

If you answered Yes, check this box if you have a physical disability that affects how you access our services.

Check this box if you do NOT have a disability that affects how you access our services.

If you answered Yes, check this box if you have an intellectual disability that affects how you access our services.

Check this box if you are responding to someone else's protection order application in relation to the domestic/family violence matter. Fill only if 'Domestic/family violence (Give details)' is 'Yes'.

Check this box if you are applying for a protection order related to the domestic/family violence matter. Fill only if 'Domestic/family violence (Give details)' is 'Yes'.

Check this box if you are seeking changes to existing family court orders because of domestic or family violence. Fill only if 'Domestic/family violence (Give details)' is 'Yes'.

Check this box if your application concerns domestic or family violence and you will provide details in the space provided. Fill only if 'Q13 - Yes' is 'Yes'.

Enter the email address and any brief instructions or details you will use when emailing your application to Legal Aid Queensland.

Check this box when you need to provide additional details related to Question 18 (use the table above to list the extra information).

Describe any extra or practical help you need to access services (for example help to read, write, hear, or move), giving specific details so staff can provide appropriate support. Fill only if 'Do you need extra or practical help to access our services? — Yes' is 'Yes'.

Check this box if you do NOT need any extra or practical help (for example help to read or write) to access the services.

Check this box if you DO need extra or practical help (for example help to read or write) to access the services.

Check this box when you have selected Yes and want to provide details about the extra or practical help you need.

Enter the fifth child's family name (surname). Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the fifth child's first name and any middle name(s). Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the fifth child's relationship to you (for example: son, daughter, stepchild, foster child). Fill only if 'Question 16 - Yes' is 'Yes'.

Specify who the fifth child lives with (names or relationship such as mother, father, guardian). Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the fifth child's date of birth. Fill only if 'Question 16 - Yes' is 'Yes'.

Indicate whether the fifth child is involved in this matter and provide brief details if applicable. Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the first child's given name and any middle names. Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the first child's family (last) name. Fill only if 'Question 16 - Yes' is 'Yes'.

Enter how the first child is related to you (for example, son, daughter, stepchild). Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the first child's date of birth. Fill only if 'Question 16 - Yes' is 'Yes'.

State whether the first child is involved in this matter and briefly describe the involvement if applicable. Fill only if 'Question 16 - Yes' is 'Yes'.

Enter who the first child currently lives with (give name(s) or relationship, e.g., mother, father, guardian). Fill only if 'Question 16 - Yes' is 'Yes'.

Check this box if the first person charged currently has a lawyer (then provide the lawyer's details below if known).

Check this box if the first person charged does not have a lawyer.

Check this box if you do not know whether the first person charged has a lawyer.

Enter the lawyer’s full street address for the first person charged, including unit or street number if applicable. Fill only if 'Yes - Do they have a lawyer?', 'Yes' are 'Yes' (all fields selection).

Enter the suburb or town of the lawyer’s office for the first person charged. Fill only if 'Yes - Do they have a lawyer?', 'Yes' are 'Yes' (all fields selection).

Enter the name of the law firm that represents the first person charged, if known. Fill only if 'Yes - Do they have a lawyer?', 'Yes' are 'Yes' (all fields selection).

Enter the full name of the lawyer representing the first person charged (given name(s) and family name). Fill only if 'Yes - Do they have a lawyer?', 'Yes' are 'Yes' (all fields selection).

Enter the state or territory where the lawyer’s office is located for the first person charged. Fill only if 'Yes - Do they have a lawyer?', 'Yes' are 'Yes' (all fields selection).

Enter the postcode for the lawyer’s address for the first person charged. Fill only if 'Yes - Do they have a lawyer?', 'Yes' are 'Yes' (all fields selection).

Enter the family (last) name of the first person charged. Fill only if 'Yes' is 'Yes'.

Enter any middle name(s) of the first person charged, or leave blank if none. Fill only if 'Yes' is 'Yes'.

Enter the given (first) name of the first person charged. Fill only if 'Yes' is 'Yes'.

Enter the street address (house number and street name) for the first person charged. Fill only if 'Yes' is 'Yes'.

Enter the suburb or town for the first person charged's residential address. Fill only if 'Yes' is 'Yes'.

Enter the birth date of the first person charged. Fill only if 'Yes' is 'Yes'.

Enter the state or territory for the first person charged's address (abbreviation or full name). Fill only if 'Yes' is 'Yes'.

Enter the postcode for the first person charged's address. Fill only if 'Yes' is 'Yes'.

Enter the fourth child's family (last) name as it appears on official documents. Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the fourth child's first name and any middle name(s). Fill only if 'Question 16 - Yes' is 'Yes'.

Describe your relationship to the fourth child (for example: son, daughter, stepchild, foster child). Fill only if 'Question 16 - Yes' is 'Yes'.

Specify who the fourth child normally lives with (name(s) or relationship, e.g., mother, father, guardian). Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the fourth child's date of birth. Fill only if 'Question 16 - Yes' is 'Yes'.

State whether the fourth child is involved in this matter and provide brief details if applicable. Fill only if 'Question 16 - Yes' is 'Yes'.

If you selected 'Other' for Gender, enter the name of the gender, group, organisation or other details here as a short text description. Fill only if 'Other' is 'Yes'.

Check this box if you identify as female.

Check this box if you identify as a gender other than male or female, and provide details in the adjacent 'Give details' field.

Check this box if you identify as male.

Enter the full name or department title of the person to contact for grants inquiries.

Enter any additional information or notes about the current health care or pension card details that do not fit in the main card fields (for example clarification, reference, or other relevant remarks).

Enter the other person's health care or pension card number exactly as shown on their card.

Enter the expiry date shown on the other person's health care or pension card.

Check this box when the other person (the person who helps you financially) holds a Health care card and you are recording their card type.

Check this box when the other person (the person who helps you financially) holds a Pension card and you are recording their card type.

Enter the full number printed on your health care or pension card for yourself.

Enter the expiry date shown on your health care or pension card for yourself.

Check this box if you (the applicant) hold a Health care card and are entering its card number and expiry date here.

Check this box if you (the applicant) hold a Pension card and are entering its card number and expiry date here.

Enter the state, territory or region for your home address (for example NSW or VIC).

Enter the postcode for your home address.

Enter the suburb or town where your home is located.

Enter your primary home street address, including house or unit number and street name.

Check this box if you have not decided how you want to plead and need more time or advice before deciding.

Check this box if you want to enter a plea of guilty to the charges listed.

Check this box if you want to enter a plea of not guilty to the charges listed.

Check this box if you are completing the application for yourself and will read and sign the declaration shown below.

Check this box if you are currently in custody and you DO want to apply for bail.

Check this box if you are currently in custody and you do NOT want to apply for bail.

Enter the language and, if applicable, the specific dialect or variant you need the interpreter to use (e.g., Spanish - Mexican, Arabic - Levantine). Fill only if 'Interpreter needed — Yes' is 'Yes'.

Check this box if you need an interpreter to help you fill out this form.

Check this box if you do not need an interpreter to help you fill out this form.

Enter the lawyer's street address (including unit or suite number if applicable) for their office. Fill only if 'Yes' is 'Yes'.

Enter the name of the lawyer's law firm or legal practice. Fill only if 'Yes' is 'Yes'.

Enter the suburb or town where the lawyer's office is located. Fill only if 'Yes' is 'Yes'.

Enter the full name of the lawyer who is representing you. Fill only if 'Yes' is 'Yes'.

Enter the postcode for the lawyer's office location. Fill only if 'Yes' is 'Yes'.

Enter the state or territory where the lawyer's office is located. Fill only if 'Yes' is 'Yes'.

Check this box if you do not have a lawyer representing you for this matter.

Check this box if you do have a lawyer representing you for this matter.

Check this box if you have a lawyer and you will provide the lawyer’s details (name, firm, address) in the fields below. Fill only if 'Yes' is 'Yes'.

Use this field for any additional notes or to continue your answer from the main details box if you need more space to explain your situation.

Enter a one-line summary of your legal problem that captures the main issue (who is involved and what the dispute or issue is).

Provide a detailed description of your legal problem including how and when it started, who is involved, what has happened since, any financial details, and any special circumstances.

Provide a full description of your legal problem, including what the problem is, who is involved and how, when and how it started, what has happened since, and any relevant financial or special circumstances.

Enter any additional information that supports your description such as specific dates, names of people or organisations involved, amounts of money, or other particulars that clarify your situation.

Provide a detailed description of your legal problem for Entry 11, including what the problem is, who is involved and how, how and when it started, what has happened since, any financial details, and any special circumstances.

Enter any additional or continuing information for Entry 11 that did not fit in the main description box, such as extra dates, names, or clarifying details about your situation.

Enter any additional details or continuation of your answer to Question 18 describing your legal problem, or a short note such as 'See attached' if you have continued your response on a separate sheet.

Provide a detailed description of your legal problem for Entry 2, including what the problem is, who is involved, how and when it started, what has happened since, and any special circumstances that apply.

Enter any additional information for Entry 2 that continues or expands on the main description, such as financial details, dates, outcomes, or other relevant facts.

Describe your legal problem in detail, explaining what the problem is, how and when it started, what has happened since, and any relevant facts or circumstances.

Provide any additional information such as who is involved (names/relationships), important dates, financial details, or any special circumstances that apply to this situation.

Describe your legal problem in detail, including what the problem is, who is involved, how and when it started, what has happened since, and any other relevant facts.

Provide any extra information that applies to your situation such as financial details, special circumstances, or other supporting details that expand on the main description.

Provide a detailed description of this legal problem, including what it is, who is involved, how and when it started, what has happened since, and any financial or special circumstances that apply.

Enter any additional information or a brief summary related to this legal problem that did not fit in the main description, such as recent updates or clarifying facts.

Describe your legal problem in detail, including what the problem is, who is involved and how, when and how it started, what has happened since, any relevant financial details, and any special circumstances that apply to your situation.

Provide the first part of your detailed description of the legal problem for Entry 7, including what the problem is, who is involved, and when and how it started.

Continue your Entry 7 description here with any further information such as what has happened since the problem started, financial details, and any special circumstances that apply.

Provide a detailed description of your legal problem for Entry 8, including what the problem is, who is involved and how, when and how it started, what has happened since, any financial details if relevant, and any special circumstances that apply.

Use this field to add any additional details or continue your explanation for Entry 8 if the main description box is not large enough, including further facts, dates, names of people or organisations, or other relevant information.

Enter a detailed description of your legal problem, including what the problem is, how and when it started, what has happened since then, and any financial or special circumstances that apply.

Provide any extra information that supports your description such as who is involved and how they are involved, relevant dates, names of other parties, or any other details not included above.

If you selected Other for your marital status, enter the brief explanation or details describing your marital situation here. Fill only if 'Other' is 'Yes'.

Check this box if you are legally divorced.

Check this box if you have never been married and are not in a de facto relationship.

Check this box if you are in a de facto relationship (living with a partner as a couple but not married).

Check this box if you are currently legally married.

Check this box if you are separated from your spouse or de facto partner.

Check this box if your marital status is not listed among the other options.

Check this box when you need to provide further details about your marital status in the adjacent text field.

Enter the date on which your divorce from the person you are in dispute with was finalized. Fill only if 'Married to person in dispute - Yes' is 'Yes'.

Enter the date you were married to the person you are in dispute with. Fill only if 'Married to person in dispute - Yes' is 'Yes'.

Enter the date on which you separated from the person you are in dispute with. Fill only if 'Married to person in dispute - Yes' is 'Yes'.

Enter the place (city, town or country) where the marriage to the person in dispute took place. Fill only if 'Married to person in dispute - Yes' is 'Yes'.

Check this box if you were married to the person you are in dispute with.

Check this box if you were not married to the person you are in dispute with.

Check this box if you answered Yes and will provide the marriage, separation and/or divorce dates in the fields provided.

Enter your given first name exactly as it appears on official documents.

Enter any middle name(s) or initials you use, or leave blank if you have none.

Enter your family name or surname exactly as it appears on official documents.

If you selected 'Other' for Title, enter the title you use (for example 'Dr', 'Prof', etc.). Fill only if 'Title - Other' is 'Yes'.

Check this box if the person's title is 'Miss'.

Check this box if the person's title is not listed and enter the specific title in the adjacent 'Give details' field.

Check this box if the person's title is 'Mrs'.

Check this box if the person's title is 'Ms'.

Check this box if the person's title is 'Mr'.

Enter the purpose of your next court date in a few words (for example: mention, committal, directions hearing, trial); if you do not know, leave blank or use the separate 'Not sure' option. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box if you do not know or cannot state the purpose of your next court date. Fill only if 'Yes (Do you have to go to court or a tribunal?)' is 'Yes'.

Check this box if your situation does not match the listed options and you will provide details in the adjacent text field. Fill only if 'Q13 - Yes' is 'Yes'.

Check this box if you are unsure what type of help or which specific problem your application relates to. Fill only if 'Q13 - Yes' is 'Yes'.

Check this box if you would like to speak with a lawyer or arrange legal advice about your situation.

Enter brief details describing the 'Other' reason you are applying for help with a family or relationship problem. Fill only if 'Other (details)' is 'Yes'.

Enter the total number of your dependent children under 18 (including any children you pay child support or maintenance for).

Enter the name or staff identifier of the person who entered the application.

Enter the date when the application was entered.

Enter the full name (or identifying staff name) of the staff member who took the in-person application.

Enter the full name of the staff member who took the application.

Enter the date on which the application was taken.

Tick this box when the application/case should be assigned to an in-house Legal Aid lawyer for handling.

Enter the name or internal identifier (e.g., staff ID or initials) of the in-house lawyer to whom this application is being assigned. Fill only if 'Assign to in-house lawyer' is 'Yes'.

Check this box when staff have physically sighted the applicant's health care or pension card.

Check this box when the applicant's required supporting documents are attached to the application.

Check this box if office staff have identified a conflict and additional details should be recorded at question 18.

Enter the date when the office staff took or recorded this application.

Check this box (enter/mark this month box) to record the month component of the date when the application was taken by office staff.

Check this box (enter/mark this year box) to record the year component of the date when the application was taken by office staff.

Check this box (enter/mark this day box) to record the day component of the date when the application was taken by office staff.

Enter the administrative file or case number assigned to this application.

Enter the client's identification code or number assigned by the office.

Check this box when the office has no in-house capacity for the matter (and you will record who advised the applicant in the adjacent 'Advised by' field).

Enter the name, initials or staff ID of the person who provided the advice or reviewed this application. Fill only if 'No in-house capacity — Advised by' is 'Yes'.

Enter brief details or a short note explaining the lack of in-house capacity (for example a reason or reference). Fill only if 'No in-house capacity — Advised by' is 'Yes'.

Describe any other legal matters you are involved in (for example child protection or family law), including what the matter is, the parties involved, relevant dates, case or file numbers if known, and the current status. Fill only if 'Other legal matters — Yes' is 'Yes'.

Check this box if you are not involved in any other legal matters.

Check this box if you are unsure whether you are involved in any other legal matters.

Check this box if you are involved in other legal matters (for example child protection or family law); if checked, also provide the details below.

Check this box when you will provide details about other legal matters in the text box provided.

Enter the first or given name that you have previously used under another name. Fill only if 'Other Names - Yes' is 'Yes'.

Describe the type of other name entered (for example 'maiden name', 'previous married name', 'alias' or 'legal change'). Fill only if 'Other Names - Yes' is 'Yes'.

Enter the family or surname of a name you have previously used (for example a maiden name or former married name). Fill only if 'Other Names - Yes' is 'Yes'.

Check this box if you have used or currently use any other names and will provide them below.

Check this box if you have never used any other names (for example, maiden name or a previous married name).

Check this box to indicate you will list the other names you have used in the fields provided below.

Provide any additional information about your legal problem(s), including facts, dates, people involved and any other details that help explain your situation.

Enter the applicant’s declaration text, including any required statements, full name, signature details and the date to confirm that the information provided is true and correct.

Check this box if the police have applied for a domestic and family violence protection order about this matter, and enter the application date (day / month / year) in the adjacent fields. Fill only if 'Domestic/family violence (Give details)' is 'Yes'.

Check this box if you do not know whether the police have applied for a domestic and family violence protection order about this matter. Fill only if 'Domestic/family violence (Give details)' is 'Yes'.

Check this box if the police have not applied for a domestic and family violence protection order about this matter. Fill only if 'Domestic/family violence (Give details)' is 'Yes'.

Enter the date when the police applied for a domestic and family violence protection order about this matter. Fill only if 'Yes — When?' is 'Yes'.

Enter the full street or PO Box address for the contact/postal address, including unit, apartment or suite number if applicable.

Enter the suburb, town or city for the contact/postal address.

Enter the postcode or ZIP code for the contact/postal address.

Enter the state, province or region for the contact/postal address.

Enter the name of the prison or detention centre where you are currently held. Fill only if 'Are you in prison? - Yes' is 'Yes'.

Enter your Integrated Offender Management System (IOMS) reference number assigned to you in detention. Fill only if 'Are you in prison? - Yes' is 'Yes'.

Check this box if you are not currently in prison or detention.

Check this box if you are currently in prison or detention.

If you checked 'Yes', check this box and provide the name of the prison or detention centre in the adjacent field.

Enter the date when the declaration was signed.

Enter the name or signature of the person signing to confirm they have read, understood and accept the privacy and conflict of interest statement.

Check this box if the police have taken any of your belongings under a proceeds of crime order; attach a copy of the order when you select this option.

Check this box if the police have not taken any of your belongings under a proceeds of crime order.

Check this box if recreation vehicles (for example boats or caravans) are part of the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if a motor vehicle is included in the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if savings are included in the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if the home you live in is part of the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if any other real estate (not including your current home) is part of the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if superannuation, insurance payments or other valuable sellable items are part of the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box to indicate you are including property settlement matters in your application, then tick the specific items below that apply. Fill only if 'Q13 - Yes' is 'Yes'.

Check this box if shares or bonds are part of the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if there are other items not listed that are part of the property settlement. Fill only if 'Property settlement' is 'Yes'.

Check this box if you will provide details about any 'Other' items and then enter those details in the space provided.

Provide details describing any other property, assets or items that are part of the property settlement but are not covered by the listed categories (for example specific personal items, business interests, or descriptions of shared property). Fill only if 'Other' is 'Yes'.

Check this box if an application for a domestic and family violence protection order has been lodged in court and attach a copy of the application(s). Fill only if 'Domestic/family violence (Give details)' is 'Yes'.

Check this box if no application for a domestic and family violence protection order has been lodged in court. Fill only if 'Domestic/family violence (Give details)' is 'Yes'.

Check this box if you have not been charged with an offence (if checked, go to question 13).

Check this box if you have been charged with an offence and then list your charges in the table provided.

Check this box if you are NOT applying for aid for a family or relationship problem.

Check this box if you ARE applying for aid for a family or relationship problem; if checked, continue to select which specific problem applies.

Check this box to indicate you should skip the family/relationship questions and go to question 17 (typically used when you answered 'No').

Check this box if you currently have one or more family law orders (for example domestic violence protection orders, child protection orders, parenting orders) relating to this matter; also attach a copy of any orders.

Check this box if you do not currently have any family law orders relating to this matter.

Check this box if the person does not have a lawyer.

Check this box if you do not know whether the person has a lawyer.

Check this box if the person does have a lawyer.

Check this box if you can provide the lawyer's name and contact details in the fields below.

Enter the lawyer's full name (given and family names) for the legal representative of the person named in question 15. Fill only if 'Q15 Yes' is 'Yes'.

Enter the name of the law firm or legal practice where the lawyer works. Fill only if 'Q15 Yes' is 'Yes'.

Enter the lawyer's full street address, including building/unit number, street name and any PO Box details. Fill only if 'Q15 Yes' is 'Yes'.

Enter the suburb or town for the lawyer's address. Fill only if 'Q15 Yes' is 'Yes'.

Enter the postcode for the lawyer's address. Fill only if 'Q15 Yes' is 'Yes'.

Enter the state or territory for the lawyer's address (use abbreviation or full name). Fill only if 'Q15 Yes' is 'Yes'.

Enter the person's full street address including house/unit number and street name.

Enter the postcode for the person's address.

Enter the suburb or town of the person's address.

Enter the state or territory for the person's address.

Enter the person’s primary contact phone number, including area or country code if applicable.

Enter the person’s email address for contact.

Describe the person’s relationship to you (for example: spouse, parent, child, friend, other).

Enter the person’s date of birth.

Enter the person's given (first) name as it appears on official documents.

Enter any middle name(s) or additional given names of the person involved, if applicable; if none, leave blank.

Enter the family (last) name/surname of the person involved in this legal matter.

Check this box if you are not applying for aid for a civil law problem (if selected, skip to question 18).

Check this box if you are applying for aid for a civil law problem (if selected, continue to specify which problem from the list).

Check this box if your matter is an inquest. Fill only if 'Q17 Yes — Which problem?' is 'Yes'.

Check this box if your matter involves anti-discrimination law. Fill only if 'Q17 Yes — Which problem?' is 'Yes'.

Check this box if your issue concerns mental health law. Fill only if 'Q17 Yes — Which problem?' is 'Yes'.

Check this box if your problem concerns dangerous prisoners. Fill only if 'Q17 Yes — Which problem?' is 'Yes'.

Check this box if your application is about child protection; if so, go to question 13 on page 9. Fill only if 'Q17 Yes — Which problem?' is 'Yes'.

Check this box if your problem involves migration (immigration) law. Fill only if 'Q17 Yes — Which problem?' is 'Yes'.

Check this box if your application is about domestic or family violence; if so, go to question 13 on page 9. Fill only if 'Q17 Yes — Which problem?' is 'Yes'.

Check this box if your issue is about peace and good behaviour (for example breach of order). Fill only if 'Q17 Yes — Which problem?' is 'Yes'.

Check this box if your matter involves workers’ compensation. Fill only if 'Q17 Yes — Which problem?' is 'Yes'.

Check this box if you are applying for a veteran’s (war-caused) appeal or another defence-related appeal. Fill only if 'Q17 Yes — Which problem?' is 'Yes'.

Check this box if you are not sure what type of civil law problem this is; if checked, get legal advice. Fill only if 'Q17 Yes — Which problem?' is 'Yes'.

Check this box if you are applying for help with an Administrative Appeals Tribunal matter. Fill only if 'Q17 Yes — Which problem?' is 'Yes'.

Check this box if your civil law problem is not listed above and is another type. Fill only if 'Q17 Yes — Which problem?' is 'Yes'.

If you selected 'Other' for question 17, enter a short clear description of the civil law problem you are applying for help with.

Check this box if you do get financial help from another person (for example a relative or partner) who regularly gives you money, helps pay your bills, or shares living expenses.

Check this box if you do not get financial help from another person as described (no one regularly gives you money, helps pay your bills, or shares living expenses).

Enter the self-employment information for the person who financially helps you (or for yourself): e.g., business name, type of work or farming, role, and any other relevant details about the small business or farming activity. Fill only if 'Self‑employment: Yes' is 'Yes'.

Check this box if neither you nor the person who financially helps you is self‑employed, a small business owner, or a farmer.

Check this box if you or the person who financially helps you is self‑employed, a small business owner, or a farmer.

Check this box when you are providing or attaching further details about the self‑employment (see page 3 for more information).

Enter the name or brief details of any 'Other' Centrelink or Veterans' Affairs payment received by the person who helps you financially. Fill only if 'Other payment' is 'Yes'.

Check this box if the person receives Youth Allowance.

Check this box if the person receives a Disability Support Pension.

Check this box if the person receives Parenting Payment (partnered).

Check this box if the person receives Newstart Allowance.

Check this box if the person receives a Veterans' Affairs or war‑services related payment.

Check this box if the person receives Sickness Allowance.

Check this box if the person receives Widow Allowance.

Check this box if the Centrelink/Veterans' payment received is at the full rate (not a part rate).

Check this box if the person receives a Mature Age Allowance or similar mature-age pension benefit.

Check this box if the person receives a Special Benefit.

Check this box if the payment received is not listed above, and provide details in the adjacent text field.

Check this box if the person receives Single Parenting Payment.

Check this box if the Centrelink/Veterans' payment received is at a part (reduced) rate.

Check this box to indicate you will give further details about the selected/other payment in the provided text box.

Check this box if you (or the person who helps you financially) do receive a Centrelink or Veterans' Affairs payment, then specify which payment type in the options provided.

Check this box if you (or the person who helps you financially) do not receive a Centrelink or Veterans' Affairs payment; if checked, skip to question 6.

Check this box if you are a single person who is currently working.

Check this box if you are a single person who is not currently working.

Check this box if you are part of a couple and both people in the couple are working.

Check this box if you are part of a couple and neither person in the couple is working.

Check this box if you are part of a couple and only one person in the couple is working.

Check this box if you have pleaded guilty in court to the charges listed.

Check this box if you have not pleaded guilty in court to the charges listed.

Check this box if you have or had an intimate personal relationship with the other person (for example a romantic partner). Fill only if 'Domestic/family violence (Give details)' is 'Yes'.

Check this box if the person is a family member or part of your extended family and your situation involves a family relationship. Fill only if 'Domestic/family violence (Give details)' is 'Yes'.

Check this box if your relationship with the person is primarily an informal care relationship (for example, caregiver and care recipient). Fill only if 'Domestic/family violence (Give details)' is 'Yes'.

Check this box if you are or were in a spousal relationship with the other person, including married or de facto relationships. Fill only if 'Domestic/family violence (Give details)' is 'Yes'.

Check this box if none of the listed relationship types describe your situation. Fill only if 'Domestic/family violence (Give details)' is 'Yes'.

Enter the child's first name and any middle names. Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the child's family (last) name. Fill only if 'Question 16 - Yes' is 'Yes'.

State how the child is related to you (for example: son, daughter, stepchild). Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the names or relationships of the people the child lives with (for example: mother, father, guardian). Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the child's date of birth. Fill only if 'Question 16 - Yes' is 'Yes'.

Indicate whether the child is involved in this matter and provide brief details if applicable. Fill only if 'Question 16 - Yes' is 'Yes'.

Check this box if the second person charged does have a lawyer (and you will provide the lawyer’s details below if known).

Check this box if you do not know whether the second person charged has a lawyer.

Check this box if the second person charged does not have a lawyer.

Enter the lawyer's or law firm's full street address (number, street name and unit if applicable) for the second person charged. Fill only if 'Yes' is 'Yes'.

Enter the name of the law firm representing the second person charged. Fill only if 'Yes' is 'Yes'.

Enter the full name of the lawyer who represents the second person charged. Fill only if 'Yes' is 'Yes'.

Enter the suburb or town for the lawyer's address for the second person charged. Fill only if 'Yes' is 'Yes'.

Enter the postcode for the lawyer's address for the second person charged. Fill only if 'Yes' is 'Yes'.

Enter the state or territory for the lawyer's address for the second person charged. Fill only if 'Yes' is 'Yes'.

Enter the full street address of the second person charged, including house/unit number, street name and any apartment or lot details.

Enter any middle name(s) of the second person charged; leave blank if they have none or it is unknown.

Enter the first (given) name of the second person charged.

Enter the family name (surname) of the second person charged.

Enter the suburb, town or city for the second person's residential address.

Enter the second person's date of birth.

Enter the state or territory for the second person's residential address (e.g., NSW, VIC, QLD).

Enter the postcode or ZIP code for the second person's residential address.

Tick this box if you DO have special circumstances (for example long‑standing ill health, inability to read or write, or inability to access assets or money) and you will list details at question 18.

Tick this box if you do NOT have any special circumstances (for example long‑standing ill health, inability to read or write, or inability to access assets or money) to report.

Check this box if you will post your completed form to GPO Box 2449 Brisbane Q 4001 or hand-deliver it to your nearest Legal Aid office (see backpage for submission instructions).

Enter the third child's first name and any middle name(s). Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the third child's family name (surname). Fill only if 'Question 16 - Yes' is 'Yes'.

Describe your relationship to the third child (for example, 'son', 'daughter', 'stepchild' or 'foster child'). Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the third child's date of birth. Fill only if 'Question 16 - Yes' is 'Yes'.

Provide the name(s) or relationship(s) of the person(s) the third child lives with (for example, 'mother', 'father and stepmother', 'guardian'). Fill only if 'Question 16 - Yes' is 'Yes'.

State whether the third child is involved in this matter and give brief details if applicable. Fill only if 'Question 16 - Yes' is 'Yes'.

Enter the household’s total gross income before tax for one week from all sources (combined for all household members).

Enter the name of the tribunal and any relevant details (for example division, case or file number, hearing location and a brief description of the matter). Fill only if 'Tribunal — Give details' is selected.

Check this box if you are unsure whether anyone else was charged with you.

Check this box if one or more other people were charged along with you; you should then provide their details.

Check this box if no one else was charged with you; if checked, proceed to question 12.

Check this box when you will provide additional details about the other person(s) charged (used together with Yes).

Check this box if your application concerns spousal maintenance (financial support between partners or former partners). Fill only if 'Q13 - Yes' is 'Yes'.

Check this box if your application relates to child protection issues, including family group meetings. Fill only if 'Q13 - Yes' is 'Yes'.

Check this box if your application is about who your children live with or legal residence/custody arrangements. Fill only if 'Q13 - Yes' is 'Yes'.

Check this box if your application is about enforcing a court order or advising that a court order has been breached. Fill only if 'Q13 - Yes' is 'Yes'.

Check this box if your application is about child support, maintenance payments or paternity matters. Fill only if 'Q13 - Yes' is 'Yes'.

Check this box if your application is about how much time your children spend with you or the other parent (contact/access). Fill only if 'Q13 - Yes' is 'Yes'.

Check this box if your application is about divorce. Fill only if 'Q13 - Yes' is 'Yes'.

Check this box if your application concerns decisions about how your children are raised, for example schooling, health or religion. Fill only if 'Q13 - Yes' is 'Yes'.

Enter the section number that applies to the Criminal law problem row (the number shown for this row).

Enter the section number that applies to the Civil law problem row (the number shown for this row).

Enter the section number that applies to the Family or relationship problem row (the number shown for this row).

Enter the overall section number you must complete for your legal problem as shown in the 'This section is divided into' row.

Enter the full contact details for this local Legal Aid Queensland office, including office name, street address, phone number and email or website as applicable.

Enter the full contact details for this local Legal Aid Queensland office, including office name, street address, phone number and email or website as applicable.

Enter the full contact details for this local Legal Aid Queensland office, including office name, street address, phone number and email or website as applicable.

Enter the full contact details for this local Legal Aid Queensland office, including office name, street address, phone number and email or website as applicable.