Prospective Client Online Application

​Please note that you do not automatically become a client b​y submitting this form. After receiving your completed form, the LITC will contact you to set up an initial consultation meeting. After the consultation meeting, a clinician will inform you about your status.

Please bring copies of the following items (when applicable) to your first consultation:

  • IRS 30-Day Letter
  • Tax returns you filed for any year in controversy, supporting schedules that are part of the tax returns, W-2's, and other documentation relating to the tax returns
  • Any correspondence to and from the IRS
  • Any other notices recei​ved from the IRS.​
    ​
    How did you hear about us?
    First Name:
    Last Name:
    Date of Birth:
    Select a date from the calendar.
    Address:
    Preferred Telephone:
    Alternate Telephone:
    Email:
    Tax years in question:
    Amount due to the IRS:
    Briefly describe your tax issue:
    How many people are in your household (related by blood, marriage, or adoption)?
      
    Please tell us how much income you receive from the following sources. Type "N/A" if it does not apply to you.     :
    Type of   IncomeSource of Income
      (Ex: Name of your Employer)    		Amount of income/Month
    (Ex: $878/month)
    Wages  

    Unemployment  

    Social   Security/Disability

    Self-   Employment

    Rental   Income

    Gambling   Winnings

    Dividends  

    Disability  

    Child   Support

    Alimony Received

      
    Do you own any real estate?:
    If Yes, what type and where?:
    Do you own a small business?:
    Does anyone else living in your home receive income?:
    If   Yes, how much income do they receive?
      Person 1 income:
      Person 2 income:
      Person 3 income:
     

    		I hereby affirm that the financial information I have provided The University of Michigan law School Low Income Taxpayer Clinic is correct.

    ​​