Exit this survey Veterans Consortium Pro Bono Online Contract THE VETERANS CONSORTIUM PRO BONO PROGRAM Providing Representation at the U.S. Court of Appeals for Veterans Claims PRO BONO ATTORNEY AGREEMENT • I viewed the online seminar, "Providing Pro Bono Representation before the U.S. Court of Appeals for Veterans Claims," presented by the Veterans Consortium Pro Bono Program. In return for the free seminar and training materials, I agree to accept referral of one pro bono appeal before the U.S. Court of Appeals for Veterans Claims. [Completion of this training does not guarantee that you will be assigned more than one case.] • I agree to complete that appeal, serving upon the Veterans Consortium copies of all documents filed on behalf of the appellant in the appeal; and, at the conclusion of the case, providing the Veterans Consortium with a completed evaluation form. • My pro bono client(s) are entitled to professional, competent and diligent representation, and I agree to inform the Program promptly if any circumstance (a health problem, a personal problem, a work conflict, etc.) threatens to interfere with my responsibility to my pro bono client. • If needed, the Veterans Consortium will provide you with malpractice insurance coverage on any pro bono case handled pursuant to this agreement. • The Veterans Consortium will provide seminar materials and other resource materials including a Veterans Benefits Manual. The Veterans Consortium will also assign a mentor attorney to assist you. • If an appeal is in danger of dismissal because I fail to respond to a Court order, I authorize the Program to: (1) contact the pro bono client concerning the possibility of dismissal; (2) advise the pro bono client of his/her right to retain a replacement lawyer; and (3) attempt to find a replacement lawyer for the pro bono client. If the Program takes these actions, I agree to file a motion to withdraw as representative that complies with Rule 46(d)(4), and agree to forgo any claim or right that I may have to recover some or all of my fees/costs under the Equal Access to Justice Act (EAJA). In addition, I waive any right I may have to object should the Program carry out any of the actions listed above. Question Title * 1. Signature – By initialing below, you state your understanding of the above statements and take full responsibility for the terms contained therein. Initials Date Question Title * 2. Name: Question Title * 3. Direct Phone Line Question Title * 4. Fax Question Title * 5. Email Address Question Title * 6. Address Company: Address: * Address 2: City/Town: * State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Question Title * 7. Admitted to Practice Before U.S. Court of Appeals for Veterans Claims? Yes No Question Title * 8. Number of Cases? Question Title * 9. Answer all three Yes No I am a Veteran I am a Veteran Yes I am a Veteran No I am a student I am a student Yes I am a student No I am a paralegal I am a paralegal Yes I am a paralegal No Question Title * 10. "PART" Firm (for DC only): Question Title * 11. Legal Services Provider: Unless you indicate otherwise, we will make your name and address available to appropriate veterans law committees of bar associations (e.g. CAVC Bar Association; Federal Bar Association, American Bar Association, Federal Circuit, etc.) that request it, to enable them to solicit your participation in their activities. Question Title * 12. Do NOT make my name and address available Exclude Optional: Our Program is required by its funding agency to collect data on the lawyers who serve veterans pro bono. The questions below are optional and the information is collected for statistical purposes only. Question Title * 13. Gender Male Female Question Title * 14. Age Question Title * 15. Ethnic background Caucasian (white; non-Hispanic origin) Black (non-Hispanic origin) Hispanic Origin Native American Asian/Pacific Islander Other/Mixed Race Question Title * 16. Year Graduated? Question Title * 17. Law school attended? Done