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Application and Agreement for Project Referrals
Barristers AIDS Legal Services Project/
AIDS Legal Services Project


Application and Agreement for Project Referrals

If you can see this, please leave the field below blank.
Name
State Bar No.
Firm Name and Address
Telephone
Alternate Telephone
Fax
E-Mail address
Foreign Languages Spoken (including American Sign Language)

Primary area(s) of legal practice


Since volunteers are sometimes called upon to travel to hospice facilities and client's homes, please indicate the areas to which you are willing to travel:
San Fernando Valley West L.A.
East L.A. Wilshire District
Downtown/Central L.A. South Bay
San Gabriel Valley Anywhere in LA County
South Central L.A. Other
Southwest L.A.

I agree to participate in this Project on a volunteer, non-compensatory basis. If I am unable to represent a client, I will refer the client back to the AIDS Legal Services Project.

California Civil Code Section 43.95 requires us to disclose to the public the nature of any disciplinary action taken against an attorney who accepts referrals from our office.  Have you ever been a party to a disciplinary proceeding by the State Bar of California?
Yes    No
If yes, what was the date? 

Please describe in detail the nature of the disciplinary proceeding. Indicate whether any disciplinary action was taken as a result of the proceeding.


ALSP Pro-bono Referral Panels and Subpanels
Please click in the box next to the number and letter, if applicable, of the areas of law in which you will accept pro bono referrals.
1. Bankruptcy
 a. Debtor/Creditor
2. Civil Litigation

3. Conservatorship/Guardianship

4. Criminal (advice only, no ongoing representation)

5. Consumer

6. Discrimination
a. Civil Rights
b. Employment
c. Housing
d. Insurance
e. Medical
7. Estate Planning
a. Durable Powers of Attorney
b. Durable Powers of Attorney for Healthcare
c. Wills
d. Trusts
e. Probate

8. Family Law

9. Government Benefits
a. Medicare/MediCal
b. Social Security

10. Healthcare/Patients' Rights

11. Immigration

12. Insurance

13. Employment/Labor
a. Employee Benefits
14. Real Property
a. Landlord-Tenant
b. Litigation

15. Tax

16. Other:
 

In addition to accepting pro bono referrals, would you provide brief advice at legal clinics?
yes    no



If you have any questions, please telephone Laurie Aronoff at (213) 833-6776 or email Laurie at laronoff@lacba.org . Hit the submit button above or print the filled out form and send it to: Laurie Aronoff, Project Director, AIDS Legal Services Project, LACBA PO Box 55020, Los Angeles, CA 90055. Or you can fax it to (213) 833-6718.


     





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