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Complete this form to be considered for funding through the Legal Action Program. Parties requesting financial assistance must complete the Legal Action Request Form and forward it to the Office of the General Counsel at least four weeks in advance of the Legal Action Committee meeting. Advance completion of this form allows the staff to review it and request any additional information, permits the staff to provide information about the case to Committee members for their careful review prior to the meeting date, and insures that the case can be scheduled on the agenda of the Committee meeting. Failure to provide information well in advance of the meeting may eliminate the opportunity of Committee members and staff to carefully review and understand the case, which may thereby reduce the likelihood that financial assistance will be provided.