Holy Name University College of Law: Preliminary Interview Form

HOLY NAME UNIVERSITY
COLLEGE OF LAW
Janssen Heights, Dampas Dictrict,
Tagbilaran City, Bohol
Website: http://www.hnu.edu.ph
038- 411-2283 local 211
PRELIMINARY INTERVIEW FORM
PIF No. Date of Interview: Date Submitted to SL: Date of Receipt by LC:
Name of Applicant:
Name/Relationship of Representative (If interviewee is not the Applicant):
Existing Client of Legal Clinic (LC): Yes No Former Client of LC: Yes No
Age: Sex: Citizenship: Civil Status: Educational Attainment: Income/Family Income:
Source of Income: If employed, name of employer:
Applicant’s Address:
Applicant’s Tel. No.: Email:
Relator’s Address:
Relator’s Tel. No.: Email:
Address of adverse party, if any and if known:
NATURE OF LEGAL ASSISTANCE SOUGHT
Legal advice and consultation

Request for initial legal advice/opinion
Preparation of legal documents, please specify _________________________.
Legal representation
Legal Opinion
Counsel for party/ Representation
Representation in pending/existing case
Venue: ________________________
Nature of case: _____________________________
Date Filed: _____________________
Filing of original case
Nature of case: ______________________________
Possible jurisdiction/venue: ____________________
Negotiation
Clinical Eco-Justice Advocacy (CEJA), the HNU-COL legal clinic, is committed to comply with the Data Privacy Act of 2012 (R.A.10173), its implementing
Rules and Regulations to safeguard and to protect your personal data and to observe your rights as a data privacy subject. The personal data we collect
in this form shall be used to facilitate your request for legal assistance. Appropriate security measures are in place to safeguard personal data provided.
Its processing shall be in accordance with the Data Privacy Act of 2012.
Acting as a neutral and independent mediator, conciliator, arbitrator, among others
Developmental work
Assistance to LGUs, NGOs, and government agencies
Advocacy of specific public interest issues
For specific legislation
Popularization of legal aspects of current issues
Information dissemination
Others, please specify _____________________
Short narration of facts: (The back of the sheet may be used for additional space.)
Documents submitted, if any:
PEDAGOGICAL VALUE
[Discuss instructional value of the matter/s raised by this application (in addition to the value of enhancing
knowledge and recall of rules and case law). Include, in your discussion, any area of law or jurisprudence
that this application and the issues may impact on, whether directly or indirectly. On the other hand, if there
is no pedagogical value to be gained, state so and explain why.]
OTHER REASON/S FOR RECOMMENDING ACCEPTANCE OR NON-ACCEPTANCE

OF THIS APPLICATION
Date Received by the Supervising Lawyer (SL):
Recommendation of the Supervising Lawyer:
_______________________________
Signature of Supervising Lawyer
Date
Interviewing LSP: Team No./SL Level Accreditation No. Signature of LSP
APPLICANT’S ACKNOWLEDGMENT:
I hereby acknowledge that the contents of this form have been explained to me in a language which I know
and understand and that all the information I provided to the LC, including the documents or other pieces of
evidence, are true and correct of my personal knowledge. Further, in accordance with the Data Privacy Act
of 2012, I consent to the processing of my personal data for the purpose of facilitating my request for legal
assistance.
Ginakumpirma nako nga gipasabot kanako ang unod niining dokumento sa pinulungan nga akong nahibal-
an ug nasabtan, ug ang tanang impormasyon, dokumento, ug ebidensya nga gihatag ko sa LC tinuod ug
base sa akong personal nga nahibal-an. Dugang pa niini, ug base sa Data Privacy Act of 2012, nagatugot
usab ako nga iproseso ang akong personal data tungod niining aplikasyon.
______________________________
Signature of Applicant/ Relator
Date Received by Director:
Action taken by Director: Assigned to LSP: _______________

Approved
Disapproved
Others
Date: ________________________

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HOLY NAME UNIVERSITY

PRELIMINARY INTERVIEW FORM

Name/Relationship of Representative (If interviewee is not the Applicant):

Source of Income: If employed, name of employer:

NATURE OF LEGAL ASSISTANCE SOUGHT

Legal advice and consultation

Others, please specify _____________________

Documents submitted, if any:

OTHER REASON/S FOR RECOMMENDING ACCEPTANCE OR NON-ACCEPTANCE

Recommendation of the Supervising Lawyer:

Date Received by Director:

Action taken by Director: Assigned to LSP: _______________

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