VOLUNTEER REGISTRATION FORM Homeless 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: Mailing Address: City: Telephone: ______________ State: (home) Zip Code: Fax: ______________________________________ (w ork) E-mail: ___________________________________ Date: ___ ____

Name of firm, school or place of employment:________________________________________________________________ Your occupation:_________________________________ Name of Pro Bono Coordinator: _______________________________ Jurisdiction(s) of Bar Membership:______________________________ Year Admitted to Bar: _____________________________ Counties (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) Bankruptcy Business contracts, etc. Civil Liberties Consumer Law Credit Discrimination Cases Domestic Relations Law for Senior Cit izens Employment Dispute ___ Expungement of Criminal Records ___Federal Workers' Comp. Guardianship Immigration Juvenile Landlord/Tenant Mental Health Law ___ Public/Subsidized Housing _ Real Estate _ Social Security Disability ___ Other Public Benefits _ Unemployment Compensation _ Veterans Administration _ Zoning ____ Probate

Please check the type of volunteer activity you are interested in below:
___ I w ould like to do intake at a shelter or soup kitchen on a monthly basis and to do follow up advocacy and representation of homeless individuals for Expungement. ___ I w ould like to handle cases on referral, in the area of Veterans Benefits. I w ould like to serve as a consultant to other volunteer attorneys in the areas of law checked below . Bankruptcy Business contracts, etc. Civil Liberties Consumer Law Credit Discrimination Cases Domestic Relations Law for Senior Citizens Employment Dispute ___Expungement of Criminal Records Federal Workers' Comp. Guardianship Immigration Juvenile Landlord/Tenant Subsidized Housing ___ Mental Health Law ___ Probate _ Real Estate _ Social Security Disability ___ Other Public Benefits ___ Unemployment Comp. ___ Veterans Administration _ Zoning

FOR ATTORNEY VOLUNTEERS ONLY I hereby certify that I am in active legal practice and not currently subject to any disciplinary proceedings under 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 Representation Project if I am suspended or disbarred from the practice of law in Maryland. ___________________
Date

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Signat ure of At t orney

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