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Access to Justice Application Form
Attorney Name
Business Address
City
State
Zip
Business Phone
Business Email
Will offer Pro Bono
Yes
No
Will offer reduced rates to Clinic Referals
(under $75.00/hr fixed rate)
Yes
No
I can advise and/or mentor students in the following areas
I can accept referrals in:
(Use Ctrl key to select multiple items)
Landlord/Tenant
Family
Tort
Bankruptcy
Wills
Criminal
Indian
Workers Comp
Consumer
Tax
Business
Nonprofit
Other
I am proficient in the following language(s):
(other than English)
I am licensed to practice in:
State
Federal
Tribal
I certify that I am a Malpractice Insurance Holder
Yes
No
