Legal Pro Bono Request

LEGAL PRO BONO REQUEST

This Legal Pro Bono Request is submitted by Client Name: (hereinafter "Client") to Pro Bono Organization: (hereinafter "Provider") on Date of Request: .

RECITALS

WHEREAS, Client seeks legal assistance with the matter described in Section 2 below and represents that Client cannot reasonably afford counsel on a private-pay basis; and

WHEREAS, Provider administers or facilitates pro bono legal services and will consider intake criteria, conflicts, and available volunteer counsel in determining whether to accept Client for assistance; and

WHEREAS, the parties desire to set forth the terms under which Provider will evaluate and, if accepted, provide limited legal services to Client.

NOW THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the parties agree as follows:

1. IDENTIFICATION & CONTACT

2. DESCRIPTION OF MATTER

Nature of legal issue (select all that apply): Family Law Housing/Eviction Immigration Consumer/Debt Other

3. ELIGIBILITY & FINANCIAL INFORMATION

Client certifies under penalty of perjury that the financial information provided below is true and accurate and that Client lacks sufficient funds to retain private counsel at this time.

4. CLIENT REPRESENTATIONS & AUTHORIZATIONS

Client represents that the facts set forth in this Request and in any attachments are true and complete to the best of Client's knowledge. Client authorizes Provider to verify financial and identity information, to obtain publicly available records, and to perform a conflicts check. Client authorizes third parties to release records to Provider where necessary for intake evaluation and representation.

I consent to Provider requesting financial documentation (pay stubs, benefits statements) to evaluate eligibility.
I consent to a conflicts check, which may include a search of Provider and volunteer attorney records.

5. LIMITED SCOPE, NO GUARANTEE

Provider's acceptance of this Request does not guarantee representation. If accepted, representation may be limited in scope (for example, brief advice, drafting a single document, or representation for discrete proceedings). Provider will notify Client in writing of the scope of any accepted representation. Client acknowledges that Provider does not guarantee a particular outcome and that volunteer counsel may withdraw consistent with professional and ethical obligations.

6. CONFLICTS, WITHDRAWAL, TERMINATION

Provider may decline or terminate services if a conflict of interest is identified, if Client provides false or misleading information, if Client fails to cooperate or pay required administrative costs, or for other good cause. Termination of services shall be effective upon written notice to Client. Provider and volunteer counsel shall take reasonable steps to avoid prejudice to Client in the event of withdrawal.

7. CONFIDENTIALITY & ATTORNEY-CLIENT PRIVILEGE

Communications made for the purpose of obtaining legal advice are subject to the attorney-client privilege and shall be maintained in confidence to the extent required by law. Client acknowledges that privileged communications may be disclosed where necessary to evaluate intake, conflicts, or where otherwise required by law.

8. DOCUMENTS, COSTS & FEE ARRANGEMENTS

Unless otherwise agreed in writing, Provider does not pay court filing fees or other third-party expenses. Client agrees to disclose any offer of fee waivers or other funding sources. If an agreement is reached for representation, any fee arrangement, cost responsibility, or retainer will be documented in a separate written engagement agreement between Client and the assigned counsel.

9. NOTICES

Any notice required or permitted under this Request shall be in writing and sent to the contact information provided above. Notices are effective upon personal delivery, electronic transmission acknowledged by the recipient, or three (3) days after deposit in the mail with first-class postage prepaid.

10. AMENDMENT, WAIVER, COUNTERPARTS

This Request may be amended only by a written instrument signed by both parties. No waiver of any provision hereof shall be effective unless in writing and signed by the party against whom enforcement is sought. This Request may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one instrument.

11. GOVERNING LAW

This Request shall be governed by and construed in accordance with the substantive laws of the state where Provider maintains its principal place of operations, without regard to its conflict-of-law provisions.

12. ENTIRE AGREEMENT

This Request, together with any written acceptance and any subsequent engagement agreement, constitutes the entire understanding between the parties with respect to the subject matter herein and supersedes all prior discussions and agreements, whether oral or written.

13. SEVERABILITY

If any provision of this Request is held to be unenforceable or invalid, that provision shall be modified to the extent necessary to make it enforceable and valid, or if modification is not possible, such provision shall be severed and the remaining provisions shall remain in full force and effect.

14. ATTACHMENTS & SUPPORTING DOCUMENTS

By signing below, Client certifies the foregoing information is true and complete, and Provider acknowledges receipt of this Request for the purpose of intake review only.

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