Volunteer Form

Middle Name:

Preferred Name:

Pronunciation:

Hourly Rate:

Secondary Phone:

Secondary Email:

Primary County:

Birthdate:

We strive to offer programs and services that resonate with the full diversity of the communities we serve. We are asking the following questions to help us ensure that we are meeting this goal. Please note that responses to these questions have no bearing on your eligibility for services and that the data collected will only be used in the aggregate; individual applicant's answers to these questions are confidential.

Which of the following best describe you?

Gender Self-description:

I identify as:

Race Self-description:

How would you describe your sexual identity:

Sexual Identity Self-description:

How do you describe your ability status?

Are you a veteran?:

Languages:

Facebook:

LinkedIn:

Twitter:

Available for:

Speaker Bureau Experience:

Practice Areas:

Bar ID Number:

Date Admitted to BAR:

States Admitted Bar:

Law School:

Do you carry professional liability insurance?

By submitting this application you acknowledge that the aforementioned information is true and accurate to the best of your knowledge and you further agree to the following:

(a) pro bono clients are entitled to the same standard of care and protections of the attorney-client relationship as are paying clients; (b) I will not accept a matter referred to me by PVLA if the referral could result in a conflict of interest; (c) I will track hours spent in pro bono work for PVLA-referred matters and will provide this and billing rate information to PVLA for general reporting purposes upon request; (d) I will inform PVLA promptly regarding a change in contact information, attorney license status, PVLA volunteer status, practice areas or employment.

Agree All Terms: