October 26, 2012-Boston, MA-Veterans Consortium Pro-Bono Program Training App & Contact Form

1. Default Section

1. First Name
2. Last Name
(Note: This address will be used by the Program and by your client. Please do not enter a P.O. Box address.)
3. Contact Information
4. Telephone/Fax
5. Size of Organization/Firm
6. Have you previously applied for or attended a PBP training?
7. Location and date of training you are interested in attending (if known)
8. How did you find out about the Pro Bono Program?
9. Organization's/Firm's Pro-Bono Contact (if any):
10. Law school attended?
11. Year of Graduation from law school? (write in none if not graduated law school)
12. How many years have you been licensed to practice law?
13. Main areas of practice (check all that apply)?
14. If you chose JAG/MILITARY as one of your practice areas, describe your practice areas/specialties within the JAG/military
15. When (date) are you available to take a case (leave blank if no restriction)?
16. Bar status
17. State in which you are Licensed (NA if not licensed)
18. Bar Number (if your state does not issue bar numbers, enter NA)
19. If you are licensed in more than one state or have ever been licensed in a state other than the one listed above, place the information in the box below
20. Have you ever been, or are you currently, the subject of a disciplinary complaint or been refused admission to practice, disbarred, suspended, reprimanded, sanctioned, or held in contempt by any court, administrative agency or regulatory body?
21. Additional languages spoken:
The Next Three Questions are Optional.

The Veterans Consortium Pro Bono Program requests demographic information from attorneys who volunteer for our Program. Any information that we collect is compiled for statistical purposes only in response to requirements of our federal grant. Your answers are optional. There is no penalty for declining to provide this information.

22. Your age:
23. Ethnic background
Thank you for taking the time to consider these questions.
24. Gender
25. Any additional comments?