Rural Justice Project Release Form

Rural Justice Project

Authorization for Release of Information

A signed Authorization Form allows Legal Aid Society of Greater Cincinnati and/or Legal Aid Society of Southwest Ohio (“Legal Aid”), and any of its attorneys, paralegals, or other staff, to communicate with and disclose to the organization chosen below (submitting a request for legal assistance on my behalf) information regarding my request for legal assistance, the status of my referral, and application eligibility details.

Please fill in the form below and click the submit button. This will create the Release of Information form for you to digitally sign. Once you digitally sign the document, it will be sent to the Legal Aid Society of Greater Cincinnati.

Name(Required)

Date of Birth(Required)

Email(Required)

Submitting Organization(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Rural Justice Project

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