Please enable JavaScript in your browser to complete this form.1. Name *FirstLast2. Select One *— Select Choice —AttorneyParalegalLegal AssistantLaw StudentOther ProfessionalIf you select Attorney, please complete questions #3. If you select Other Professional, please complete question #4.3a. Where are you admitted to practice?3b. Attorney ID Number to please If 3c. Year Admitted to Practice3d. Active StatusYesNo3e. Disciplinary ActionsYesNoIf you selected “Other Professional” in Question 2, please list your title:5. Email *6. Phone7. Organization8. Main Practice Concentration9. Areas of Interest *Birth CertificatesFOIA Requests, FBI Background Checks, and/or Replacement Immigration DocumentsSSI/SSDI (SOAR)In Person General Legal ClinicsIn Person Subject Matter Legal Clinics (for birth certificates or estate planning documents)Criminal ExpungementsHousing Judgment SatisfactionName ChangeSimple Estate PlanningOtherSelect any that apply and/or fill in other interests in question 10.10. Other Pro Bono Areas of Interest11. How did you hear about HAP? *• Do you speak any languages besides English? If so, please list: Submit Questions or Concerns? Contact HAP Pro Bono Manager Maggie Oberkircher, Esq. at [email protected].
