Exit Access to Justice PRO BONO & MODEST MEANS REGISTRATION FORM Question Title * 1. Name Question Title * 2. Firm Name Question Title * 3. Address Question Title * 4. Phone Question Title * 5. Email Question Title * 6. I am a(n) Attorney Law Student Question Title * 7. I speak the following foreign languages: Question Title * 8. I read the following foreign languages: Question Title * 9. I have malpractice insurance Yes No Question Title * 10. I volunteer to take the following number of pro bono cases each year: Question Title * 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) Question Title * 12. I can take cases in the following counties: Question Title * 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. Done