7/29/2019 ATTYFORM-March2013

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VOLUNTEER REGISTRATION FORMHomeless Persons Representation Project, Inc.

201 N. Charles Street, Suite 1104, Baltimore, MD 21201 410-685-6589 x14

Fax: 410-625-0361 E-mail: hprpprobono@hprplaw.org

Name: Date: ___ ____

Mailing Address: ______________

Cit y: State: Zip Code: Fax: ______________________________________

Telephone: (home) (w ork) E-mail: ___________________________________

Name of f irm, school or place of employment :________________________________________________________________

Your occupat ion:_________________________________ Name of Pro Bono Coordinator: _______________________________

Jurisdict ion(s) of Bar Membership:______________________________ Year Admit ted to Bar: _____________________________

Count ies (including Baltimore City) that you are interested in serving: ___________________________________________________

Language(s) Spoken (please circle): Spanish, French, German, Russian, Chinese, Korean, Other:____________________________

I currently practice law in the follow ing areas (check all that apply)

BankruptcyBusiness cont racts, etc.

Civil LibertiesConsumer LawCreditDiscrimination CasesDomestic RelationsLaw f or Senior Citizens

Employment Dispute___ Expungement of Criminal Records

___Federal Workers' Comp.GuardianshipImmigrationJuvenileLandlord/TenantMental Health Law

___ Public/Subsidized Housing_ Real Estate

_ Social Security Disability___ Other Public Benef its

_ Unemployment Compensation_ Veterans Administ ration_ Zoning

____ Probate

Please check the type of volunteer activity you are interested in below:

___ I w ould like t o do intake at a shelter or soup kitchen on a monthly basis and to do follow up advocacy andrepresentation of homeless individuals forExpungement.

___ I w ould like t o handle cases on referral, in the area of Veterans Benefits.

I would like to serve as a consultant to ot her volunteer att orneys in the areas of law checked below.

BankruptcyBusiness cont racts, etc.Civil LibertiesConsumer LawCreditDiscrimination CasesDomestic RelationsLaw f or Senior Citizens

Employment Dispute___Expungement of Criminal

RecordsFederal Workers' Comp.GuardianshipImmigrationJuvenileLandlord/TenantSubsidized Housing

___ Ment al Health Law___ Probate

_ Real Estat e_ Social Security Disability

___ Other Public Benef its___ Unemployment Comp.___ Veterans Administ ration

_ Zoning

FOR ATTORNEY VOLUNTEERS ONLY

I hereby certify that I am in active legal practice and not currently subject to any disciplinary proceedingsunder 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 RepresentationProject if I am suspended or disbarred from the practice of law in Maryland.

___________________ _________________________________________________Date Signature of At torney

Thanks for applying with us! For any questions, please contact Katie Scott at hprpprobono@hprplaw.org