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Access to Justice
PRO BONO & MODEST MEANS REGISTRATION FORM
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1.
Name
(Required.)
2.
Firm Name
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3.
Address
(Required.)
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4.
Phone
(Required.)
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5.
Email
(Required.)
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6.
I am a(n)
(Required.)
Attorney
Law Student
7.
I speak the following foreign languages:
8.
I read the following foreign languages:
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9.
I have malpractice insurance
(Required.)
Yes
No
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10.
I volunteer to take the following number of pro bono cases each year:
(Required.)
11.
My areas of interest are:
Adoption
Bankruptcy/Debtor Relief
Collections
Contracts/Warranties
Credit Access
Custody/Visitation
Divorce
Education
Energy (non-public utilities)
Federal Subsidized Housing Rights
Guardianship/Conservatorship
Homeownership/Real Property
Job Discrimination
Landlord/Tenant
Loans/Installment
Purchases
Medicaid
Medicare
Other Consumer
Other Employments
Other Family
Other Health
Other Housing
Other Public Housing
Paternity
Public Utilities
Unfair Sales Practice
Wage Claims
Wills/Estates
Other (please specify)
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12.
I can take cases in the following counties:
(Required.)
13.
Other Items:
I will participate in the Modest Means Program. I understand that by doing so, I agree to take one A2J referred pro bono case each year.
I am willing to mentor or advise a pro bono or modest means program attorney with their case.