If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Please let us know how many pro bono civil legal matters you will accept from the Legal Aid Society per year. * 1 case/year 2-5 cases/year 6-10 cases/year Over 10 cases/year In which areas of law will you accept referrals? (Check all that apply) ANY AREA Albany County Family Court Help Center Attorney for the Day Bankruptcy Closing the Gap Consumer Custody Divorce Domestic Violence Education Employment (Other than UIB) Evictions Family Foreclosure Health Health care proxies Housing (other than eviction) Incorporation Medicaid Medicare Separation Agreements SSI Support Visitation UIB Wills/Estates Other Specify: Listed below are the counties that we serve. Please check the counties from which you can accept referrals. (Check all that apply.) Albany Clinton Columbia Essex Franklin Fulton Greene Hamilton Montgomery Rensselaer Saratoga Schenectady Schoharie St. Lawrence Warren Washington Do you speak a language other than English? Yes No If so, what languages: How many years have you practiced? Practice Setting: 2-5 attorney firm 6-10 attorney firm 11-25 attorney firm Over 25 attorney firm Government Sole Practitioner Corporation/business Retired Other If other, please specify: LAS, in addition to paying for out-of-pocket expenses for referred cases, provides other assistance to its pro bono volunteers, including a Certificate of Indigence and professional liability insurance secondary to any malpractice insurance you may have. Please let us know if you are interested in the following assistance: CLE as authorized by OCA rules Training Specify area(s): Use of LAS law library Co-counseling with experienced LAS attorneys Consultation with LAS legal staff Access to LAS pleadings/form files/brief bank Case law updates Specify area(s): "How-to" forms and materials Specify area(s): Legal Aid would welcome your help in other ways besides accepting referral of cases. In which other ways can you help? Recruit other pro bono attorneys Educate poor people on their rights and responsibilites Mentor a less experienced attorney Assist with Pro Se Clinics Train LAS staff or other private attorneys Specify area of law or skill: Advise LAS staff regarding the handling of cases Specify area(s): Assist in the creation of community legal education materials or training materials.