Pro Bono Application

I am willing to provide service to a low income client or child on an uncompensated basis during the upcoming year. I have indicated below the types of cases I would consider accepting for pro bono representation. No potential client will be given my name without my specific approval. All potential clients will be screened for financial eligibility through Kansas Legal Services. Many of the cases referred will be cases that KLS cannot accept due to conflicts or other barriers. Clients using this program understand that the attorney has agreed to provide services at no cost for the referred case only. Clients also understand that they may be required to pay filing fees, witness fees, etc. Acceptance of the case is with no expectation of payment for my time or office expenses. KLS may be able to help with extraordinary litigation expenses, when the interests of justice require it.

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* 1. Contact Information

Name:

Supreme Court ID#

Mailing Address:

City/Town:

State:

ZIP:

County:

Email Address:

Phone Number:

Fax:

Name:

Supreme Court ID #:

Mailing Address:

City, State and ZiP:

Phone:

Fax:

Email:

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* 2. I am a lawyer in good standing with the Kansas Supreme Court.

Yes

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* 3. I have professional liability insurance.

Yes

Name of Company

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* 4. I am interested in (select all that apply):

Support Our Troops (Veterans) Project

Elder Law Advice Line

Direct services to low income clients

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* 5. I will take approximately this many pro bono cases per year:

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* 6. I will serve the following counties:

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* 7. Year admitted to the bar:

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* 8. States in which I am licensed to practice:

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* 9. Types of Cases (select all that apply)

Divorce with children

Divorce without children

Child support/visitation

Paternity

Adoption

Civil Restraining Order

Domestic Abuse (PFA hearings)

Defense/Negotiation of Tenant

Defense/Negotiation re Collection

Tort Defense

Denial of State Public Benefits

Annulment

Home Foreclosure

Bankruptcy (Simple Chapter 7)

Insurance Policy Problems

Guardian/conservatorship

Post Judgment Domestic

Simple Will Preparation

Social Security Disability

Immigration Law

Unemployment Compensation

Willing to meet with pro se individuals for limited scope document review

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* 10. This or these are new area(s) or law for me, please match me with a mentor.

Yes

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* 1. Contact Information

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* 2. I am a lawyer in good standing with the Kansas Supreme Court.

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* 3. I have professional liability insurance.

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* 4. I am interested in (select all that apply):

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* 5. I will take approximately this many pro bono cases per year:

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* 6. I will serve the following counties:

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* 7. Year admitted to the bar:

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* 8. States in which I am licensed to practice:

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* 9. Types of Cases (select all that apply)

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* 10. This or these are new area(s) or law for me, please match me with a mentor.

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* 11. Thank you for completing the application. You will be contacted by your local KLS office. Comments?