Volunteer Attorney Form

Name

First Last

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Fax

Email

EIN/SSN

State(s) where licensed and in good standing to practice law.

State	Date of Admission

Have you ever been reprimanded or suspended by any Court, Bar Entity or Grievance Authority?*

Yes
No

If so, please list the entity, the reason, and the dates of any suspension.

Court, Entity, or Authority	Reason	Dates of Suspension

Have you ever been held in contempt?*

Yes
No

If so, please list the court, the reason, and the date(s) of any contempt.*

Court	Reason	Date(s)

Have you ever been sued for malpractice?*

Yes
No

If so, please list the dates, court and outcome below.*

Court	Outcome	Date

Community Legal Services provides liability insurance for all of our cases and clinics. However, a copy of declaration page of your professional liability insurance must be submitted with this form.

Please upload the declaration page from your liability insurance.

Max. file size: 16 MB.

If you do not have professional liability insurance, please state the reason.

I am willing to accept pro bono cases.

Yes
No

I may request fees to be paid by opposing party or from a substantial settlement in pro bono cases.

Yes
No

I will also accept reduced fee cases with the understanding that for each reduced fee case I must also accept a pro bono case.

Yes
No

I would be interested in providing advice in one of CLS's self-represented clinics.

Yes
No

Please indicate clinics of interest:

Family Law - Upper Marlboro Courthouse
Latino Outreach, Family Law - Langley Park
Workers' Rights - Langley Park
General Civil Law - Suitland Clinic

Please list languages spoken other than English, if any:

Practice Areas

Number of years of practice in Prince George's County:

Family Law

Yes
No

Years of experience: