Pro Bono Reporting Form

Docket #
Pro Bono Hours
Case Type
Final Case Disposition
- Brief Services
- Counsel & Advice
- Court Decision
- Extensive Services w/Final Judgment
- Extensive Services w/out Final Judgment
Other
Pro Bono Attorney Information:
Bar #
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Client Information:
Name
First Last
Zip Code:
D.O.B.
Gender
Is Client a Veteran?
- Yes
- No
Is Client Disabled?
- Yes
- No
Race
Annual Income
Source of Income:
- Employment
- Public Assistance
- Other
Are you available for another pro bono case?
- Yes
- No
Please submit any additional comments.

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Pro Bono Attorney Information: