Attorney Volunteer Registration Form

VOLUNTEER REGISTRATION FORM Homeless Persons Representation Project, Inc. 1800 N. Charles Street, Suite 206, Baltimore, MD 21201 410-685-6589 x14 Fax: 410-625-0361 E-mail: [email protected]

Name:

Date:

Mailing Address:

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City:

State:

Telephone:

Zip Code:

Fax: __________________________________________

(home)

(work) E-mail:

Name of firm, school or place of employment:_______________________________________________________________ Your occupation:______________________________________Name of Pro Bono Coordinator: ___________________________ Jurisdiction(s)of Bar Membership:______________________________Year Admitted to Bar: ______________________________________ Counties (including Baltimore) that you are interested in serving _____________________________________________________________ Language(s) Spoken (please circle) Spanish, French, German, Russian, Chinese, Korean, other __________________________________ I currently practice law in the following areas (check all that apply) Bankruptcy Business contracts, etc. Civil Liberties Consumer Law Credit Discrimination Cases Domestic Relations Law for Senior Citizens

Employment Dispute ___ Expungement of Criminal Records ____Federal Workers' Comp. Guardianship Immigration Juvenile Landlord/Tenant Mental Health Law

___ Public/Subsidized Housing Real Estate Social Security Disability ___ Other Public Benefits Unemployment Compensation Veterans Administration Zoning ___ Probate

Please check the type of volunteer activity you are interested in below: ___ I would like to do intake at a shelter or soup kitchen on a monthly basis and to do follow up advocacy and representation of homeless individuals for Expungement. ___ I would like to handle cases on referral, in the area of Veterans Benefits. I would like to serve as a consultant to other volunteer attorneys in the areas of law checked below. Bankruptcy Business contracts, etc. Civil Liberties Consumer Law Credit Discrimination Cases Domestic Relations Law for Senior Citizens

Employment Dispute ___Expungement of Criminal Records Federal Workers' Comp. Guardianship Immigration Juvenile Landlord/Tenant Subsidized Housing

___ Mental Health Law ___ Probate Real Estate Social Security Disability ___ Other Public Benefits ___ Unemployment Comp. ___ Veterans Administration Zoning

FOR ATTORNEY VOLUNTEERS ONLY I hereby certify that I am in active legal practice and not currently subject to any disciplinary proceedings under Subtitle BV of the Maryland Rule of Procedure. I hereby certify that I am duly admitted to practice before the Court of Appeals of Maryland and am presently a member in good standing, and I will immediately notify the Homeless Persons Representation Project if I am suspended or disbarred from the practice of law in Maryland. ___________________

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Date

Signature of Attorney