UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK PRO BONO PANEL APPLICATION Name (Last) First Middle Name of Firm Business Address City State Zip Code E-mail Telephone (area code and number) Are you fluent in one or more foreign languages?*Yes No If yes, please specify: DATE OF EDNY ADMISSION / / OTHER ADMISSION(S): mm dd yy TYPE OF CASE(S) Civil rights Employment Discrimination YOU WOULD PREFER TO REVIEW Social Security No preference COMMENTS REGARDING QUALIFICATIONS OR AVAILABILITY: Applicants Signature Date Pro Bono Panel Application - U.S. District Court-EDNY Rev. 2/2003