Modest Means Program Client Application

The Modest Means Program (MMP) is a reduced-rate referral program designed to help fill the gap by making legal services accessible to moderate-income people whose income is too high to qualify for legal aid. Participating attorneys agree to charge the client no more than a $500 retainer and $75 per hour. Attorney’s fees, filing fees and out-of-pocket costs must be paid by the client.

Note: Required fields are marked with an asterisk ( * )

Applicant Information

Address

Employment Information

Case Information

Type of Proceeding *

Financial Information

$
$
$
$
$

Others in Household Receiving Income

$
$
$

Client Certification and Authorization

Please initial each box indicating that you have read, understand and agree to each statement.

1.   I certify that all above information made by me is true. I am aware that if any of the above information made by me is inaccurate, I may not qualify for the Modest Means Program. *
2.   I will inform my attorney(s) of any material changes in my financial status that may make me ineligible for the Modest Means Program. *
3.   I understand that terms of representation and fees are between myself and the attorney. *
4.   I understand that attorney's fees, filing fees and other out-of-pocket costs are my responsibility. *
5.   I understand that submittal of this form does not automatically qualify me for the Modest Means Program. *
6.   I authorize all of my employers to share any wage information requested by the Wyoming State Bar or a participating attorney. *

Please type your name in the "Signature" box below, indicating your agreement to the terms above.