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• Answer the questions in this application to request help from Colorado Legal Services (CLS). If you might be eligible, and are done with the application, an intake staff will call you to complete the application.

• If you live in Mesa County and are a survivor of domestic violence, do not fill out this application. Instead call 970-243-7940 because the eligibility criteria are different.

• If you are being terminated from Medicaid, DO NOT use the online application. Instead, call (303) 837-1313 to complete an intake.

• DO NOT both apply at a local office and online. If you did apply online and you call a local office, let them know you completed an online application. Here is a list of CLS’ offices.

• Understand that applying online does not automatically mean you will be eligible for our services, or that we will be able to help you. This information will help us figure out if we can help you