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Pro Bono Panel Application Form. This is a New York form and can be use in District Court Federal.
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Tags: Pro Bono Panel Application Form, New York Federal, District Court
UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF NEW YORK PRO BONO PANEL APPLICATION FORM PLEASE COMPLETE THE ATTACHED PRO BONO PANEL APPLICATION FORM. ~~~~~~ PLEASE RETURN THE COMPLETED FORM TO: LAWRENCE K. BAERMAN, CLERK UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF NEW YORK P.O. BOX 7367 100 SOUTH CLINTON STREET SYRACUSE NY 13261-7367 ATTN: Philip McBrearty American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF NEW YORK PRO BONO PANEL APPLICATION FORM 1) Name: _____________________________________________________________________________ (LAST) (FIRST) (MIDDLE INITIAL) 2) Firm Name: ________________________________________________________________________ 3) Office Address:______________________________________________________________________ ______________________________________________________________________ (CITY) (STATE) (ZIP CODE) 4) County:________________________ NDNY Bar Roll No:________________________________ 5) Office Telephone No.: (_____)____________ Fax Number:(______)________________________ 6) Home Telephone No: (_____)____________ E-Mail Address:_____________________________ 7) Education: Law School:_____________________________________________________ Date:_________ College: __________________________Highest Degree obtained: __________ Date:_________ College: __________________________Highest Degree obtained: __________ Date:_________ Other: ____________________________________________________________________________ 8) Dates of Admission : A) Federal Court - Northern District of New York : _________/________/________ B) State Court - New York State:_______/_____ _/___ ___ C) Other (Circle Circuit, Federal, State, or County, indicate name of Court or Bar, and list admission date for each): Circuit / Federal / State / County __________________________________________________ Circuit / Federal / State / County __________________________________________________ Circuit / Federal / State / County __________________________________________________ Admission Date: _______/________/________ Admission Date: _______/________/________ Admission Date: _______/________/________ 9) I am fluent in a foreign language(s): YES / NO --> If Yes, please Specify:____________ 10) I have experience in the following areas of the law (check all that apply): Civil Rights (42 USC 1983) ___ Non-Prisoner Civil Rights Contract Labor Law Tort / Personal Injury Education Law Social Security ___ Environmental ___ Bankruptcy Other Primary Area of Practice: Public Positions Held: _____________________________________________________ _______________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Northern District of New York Pro Bono Panel Application Page 2 11) Civil Case Experience: 1) Number of NDNY Federal Civil Cases:__________ (List below information on the 3 most recent) Case Number: ________CV__________ Judge:_______________ Disposition: _________________ Case Number: ________CV__________ Judge:_______________ Disposition: _________________ Case Number: ________CV__________ Judge:_______________ Disposition: _________________ 2) Number of Federal Civil Appeals handled:_______________ Dated: ____________________ ____________________________________ Signature ------------------------------------------------------------------------------------------------------------------------------FOR INTERNAL USE ONLY: Date added to Pro Bono Panel: _______________ w:\pro bono\application 9/14/2010 Attorney Adm issions Clerk: ________________________ American LegalNet, Inc. www.FormsWorkFlow.com