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Report Hours
Attorney First and Last Name
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Firm Name
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Email address
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Client / Case Name
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Total Hours
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In the quarter of...
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January - March
April - June
July - September
October - December
Are you closing this matter at this time?
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Yes
No
What type of case was this?
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Abuse / Neglect (CAP Case)
Bankruptcy
Civil / Consumer or Landlord/tenant
DV, Family, Guardianship or Adoption
Foreclosure
Other
What type of service was provided?
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--select--
Court Decision
Mediator Decision
Negotiated settlement with litigation
Negotiated settlement WITHOUT litigation
Brief Service
Client Lost Contact
Client Withdrew
Change in financial eligibility
Insufficient merit to proceed
Closing CAP Case
The outcome for the client(s) was:
*
--select--
Quicker permanency achieved for the child(ren)
Better independent living services for the child(ren)
Unsuccessful
The placement outcome for the client(s) was:
*
--select--
Adoption
OPPLA/Independant Living
OPPLA/Long term licensed care
Deceased
Guardianship
Placement with relatives
Re-unification
Runaway/Absconded
Transferred to another jurisdiction
Withdrawal due to conflict
Unsuccessful
Did you assist with any of the following?
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Lessened / Eliminated psychotropic drugs
Obtained release from or prevented RTC placement
Obtained sibling Visitation
Obtained sibling placement together
DRC
Mojave / Adult mental health
SSI
Special immigrant juvenile status
U-Visa
Closing Bankruptcy Case
The outcome was...
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Obtained federal bankruptcy protection
Corrected deficiencies with filing to allow client to obtain bankruptcy
Resolved litigation issue to allow client to obtain bankruptcy
Obtained financial recovery in bankruptcy
Unsuccessful
Closing Civil / Consumer or Landlord / Tenant Case
The outcome was...
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Stopped or reduced debt collection, repossession, deficiency, judgement or garnishment
Enforced contract, warranty or legal rights
Stopped illegal action, scam or unfair/illegal contact
Prevented or overcame unfair/illegal eviction
Home saved
Obtained health benefit
Obtained estate or probate benefit relief
Obtained ADA compliance
Unsuccessful
Closing Domestic Violence, Family, Guardianship or Adoption Case
The outcome was...
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Obtained divorce and/or custody, child support, spousal support or other benefit
Obtained TPO
Obtained annulment
Obtained adoption, TPR or guardianship
Obtained modification
Stopped or prevented wrongful TPO, annulment, guardianship or other action
Unsuccessful
Closing Foreclosure Case
The outcome was...
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Home saved by loan modification
Home saved with litigation (including mediation, PJR, judicial foreclosure etc)
Home saved through other means
Foreclosure alternative achieved - SS, D/L, BK or other
Financial recovery
Unsuccessful - Loan modification denied
Unsuccessful - Litigation
Unsuccessful - Client rejected offer
Unsuccessful - Other reason(s)
Closing Other Case
The outcome was...
*
Successful
Unsuccessful
Final Questions
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Do you have any private comments you'd like to make about your experience or suggestions to improve our Pro Bono project?
Are you willing to take another Pro Bono case in the future?
--select--
Yes, right away!
Yes, but not immediately
Maybe
No, thank you
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Volunteer Attorneys
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Non-Attorney Volunteers
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