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Pro Bono Panel Application Form - New York
| Pro Bono Panel Application Form Form. This is a New York form and can be used in Northern District District Court Federal . |
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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: Tracey Donovan<<<<<<<<<********>>>>>>>>>>>>> 2 UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF NEW YORK PRO BONO PANELPRO BONO PANELPRO BONO PANELPRO 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 __________________________________________________ Admission Date: ________/________/________ Circuit / Federal / State / County __________________________________________________ Admission Date: ________/________/________ Circuit / Federal / State / County __________________________________________________ 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(ch eck all that apply): Civil Rights (42 USC 1983) Contract Tort / Personal Injury Social Security ___ Bankruptcy ___ Non-Prisoner Civil Rights Labor Law Education Law ___ Environmental Other Primary Area of Practice: _____________________________________________________ Public Positions Held: _______________________________________________________ <<<<<<<<<********>>>>>>>>>>>>> 3Northern 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: _______________ Attorney Admissions Clerk: ________________________w:\)24.4(pro bono\)24.4(application 4/8/02
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