Final Disposition Form Regular


Attorney First Name (required)

Attorney Last Name (required)

Client First Name (required)

Client Last Name (required)

What type of case are you closing?

What type of service was provided?

How many people were helped?

The client outcome was? (required)

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 assigned attorney named above:
Quarter 4 - 2016 (Oct - Dec):
Quarter 1 - 2017 (Jan- Mar):
Quarter 2 - 2017 (Apr - Jun):
Quarter 3 - 2017 (Jul - Sep):

Did additional attorneys work on this case?

Please report the total pro bono hours for any additional attorneys who worked on this case:
Additional Attorney 1:
First Name:
Last Name:

Quarter 4 - 2016 (Oct - Dec):
Quarter 1 - 2017 (Jan- Mar):
Quarter 2 - 2017 (Apr - Jun):
Quarter 3 - 2017 (Jul - Sep):

Additional Attorney 2:
First Name:
Last Name:

Quarter 4 - 2016 (Oct - Dec):
Quarter 1 - 2017 (Jan- Mar):
Quarter 2 - 2017 (Apr - Jun):
Quarter 3 - 2017 (Jul - Sep):

Additional Attorney 3:
First Name:
Last Name:

Quarter 4 - 2016 (Oct - Dec):
Quarter 1 - 2017 (Jan- Mar):
Quarter 2 - 2017 (Apr - Jun):
Quarter 3 - 2017 (Jul - Sep):

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

Additional Comments:

This form was completed by:
Name:
Phone:
Email:

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Please take a moment to SHARE YOUR CLIENT SUCCESS STORY and tell us how your pro bono service changed a client’s life for the better.