Attorney First Name (required)

Attorney Last Name (required)

Client First Name (required)

Client Last Name (required)

What type of case are you closing?

AppealBankruptcyCivil/ConsumerDomestic Violence/Family Law/Guardianship/AdoptionForeclosureHolocaust ReparationsImmigrationLandlord/TenantMiscellaneousProbate/EstateReal EstateRecords SealingTaxWork Card

What type of service was provided?

Court DecisionMediator DecisionNegotiated Settlement with litigationNegotiated Settlement without litigationBrief ServicesClient Lost ContactClient WithdrewChange in financial eligibilityInsufficient merit to proceed

How many people were helped?

—Please choose an option—12345678910

The client outcome was? (required)

—Please choose an option—APPEAL-- Successful-- UnsuccessfulBANKRUPTCY-- Obtained Federal Bankruptcy Protection-- Corrected deficiencies with filing to allow client to obtain bankruptcy-- Resolved litigation issue to allow client to obtain bankruptcy protection-- Obtained financial recovery in bankruptcy-- UnsuccessfulCIVIL/CONSUMER-- Stopped/reduced debt collection, repossession, deficiency, judgment, garnishment-- Enforced contract/warranty/legal rights-- Stopped illegal action scam; unfair/illegal contact-- Prevented or overcame unfair/illegal eviction-- Home Saved-- Obtained health benefit for client-- Obtained estate/probate benefit relief-- Obtained ADA compliance-- UnsuccessfulDOMESTIC VIOLENCE/FAMILY LAW/GUARDIANSHIP/ADOPTION-- Obtained Divorce and/or Custody, Child Support, Spousal Support or Other Benefit-- Obtained TPO-- Obtained Annulment-- Obtained Adoption/TPR/Guardianship-- Obtained Modification-- Stopped/Prevented Wrongful TPO, Annulment, Guardianship or Other Action-- UnsuccessfulFORECLOSURE-- Home Saved – Loan Modification-- Home Saved – Litigation (Including Mediation, PJR, Judicial Foreclosure, any litigation)-- Home Saved – Other (Negotiations, etc.)-- Foreclosure Alternative Achieved - SS, D/L, BK, Other-- Financial Recovery-- Unsuccessful - Loan Modification Denied-- Unsuccessful - Litigation-- Unsuccessful – Client Rejected Offer-- Unsuccessful – OtherHOLOCAUST REPARATIONS-- Obtained Reparations-- UnsuccessfulLANDLORD/TENANT-- Stopped/reduced debt collection, repossession, deficiency, judgment, garnishment-- Enforced contract/warranty/legal rights-- Stopped illegal action scam; unfair/illegal contact-- Prevented or overcame unfair/illegal eviction-- Home Saved-- Obtained health benefit for client-- Obtained estate/probate benefit relief-- Obtained ADA compliance-- UnsuccessfulMISCELLANEOUS-- Successful-- UnsuccessfulPROBATE/ESTATE-- Successful - Obtained estate-- UnsuccessfulREAL ESTATE-- Successful-- UnsuccessfulTAX-- Successful Resolution with IRS-- UnsuccessfulWORK CARD-- Work card granted- Unsuccessful

What is the dollar value of services/benefits received annually? (i.e., a $500 award in a child support is a benefit of $6,000 annually ($500 x 12))

What is the dollar value avoided? (i.e., a $10,000 debt forgiven is a $10,000 value avoided):

What amount was recovered in attorney's fees?

Please report the total pro bono hours for the attorney and case named above:

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Did additional attorneys work on this case?

—Please choose an option—YesNo

Please report the total pro bono hours for any additional attorneys who worked on this case:

Additional Attorney 1:

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Additional Attorney 2:

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Additional Attorney 3:

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Were you aware that you could get CLE credits for completing pro bono cases?

—Please choose an option—YesNo

Does the possibility of getting CLE credits make you more likely to take a pro bono cases in the future?

—Please choose an option—YesNo

If you were aware of the new CLE rule, did the possibility of getting CLE credits influence you to take this case?

—Please choose an option—YesNo

Program Feedback: please provide any suggestions, experiences, or positive or negative feedback that we may use to improve the pro bono program.

Additional Comments:

I am willing to take a NEW pro bono case.

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