Tubman Legal Services Volunteer and Referral Attorney Application

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Abraham Clifton Payne
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1 Tubman Legal Services Volunteer and Referral Attorney Application Name Office Address Office Phone ( ) Date ZIP FAX ( ) Firm Cell Phone* ( ) *This number will not be given to clients! Multiple Office Location TTY ( ) Website Year started in practice Are you a qualified family law neutral? Yes No Do you take Collaborative Law cases? Yes No Approximate division of practice (e.g. 50% family, 25% real estate, 25% criminal): Area of special interest/expertise: Regularly practice in which counties? Anoka Carver Chisago Dakota Hennepin Isanti McLeod Ramsey Scott Sherburne Sibley Stearns Washington Wright Other: Are you willing to meet clients at a location other than your office? Yes No Are you fluent in a language other than English (including ASL)? Yes No Which one? Do you want client referrals based on your ability to speak this language? Yes No Are you willing to provide an interpreter for client meetings? Yes No Are you licensed in another state? Yes No Where? Are you admitted to a tribal court? Yes No Where? Do you have experience or training in representing victims of domestic violence: Yes No representing clients with mental health issues Yes No representing clients with substance abuse issues Yes No ************************************************************************************ Current Status (Tubman completes this portion) Active Volunteer (as of ) Self-Represented Legal Clinic (Family Law) Pro Bono Family Law Representation Pro Bono Safety Project (OFPs) Law Clinic Active Referral (as of ) Leave of Absence (from to ) Inactive (as of ) 1

g. 50% family, 25% real estate, 25% criminal): Area of special interest/expertise: Regularly practice in which counties?

2 Volunteer and Referral Information Please be specific so that we can best match clients and attorneys when providing services and referrals. FAMILY LAW Divorce Child Custody & Parenting Time Paternity Child Support Interstate Child Custody/ Divorce International Child Custody/Divorce Domestic Abuse Domestic Partnership Property Rights of Unmarried Couples Spousal Maintenance Complex Marital Property/Debt Division Prenuptial Agreements Grandparent/Third Party Child Custody Post-divorce Matters & Modifications Family Law Appeals Family Law Tax Issues JUVENILE LAW Step-parent Adoption Adoption Juvenile Crime/Delinquency CHIPS (Child in Need of Protection or Services) Voluntary Placement Termination of Parental Rights Appeal of Termination of Parental Rights GLBT ISSUES Domestic Partnership Child Custody & Parenting Time Domestic Abuse Property Separation and Uncoupling Testamentary and Planning EMPLOYMENT LAW Wrongful Termination Unemployment Benefits Workers Compensation Employment Discrimination/Harassment Family or Medical Leave Employee Privacy Wages and Overtime Employment Disqualification Reviews CIVIL LITIGATION Conciliation Court General Civil Litigation Personal Injury--Accidents Personal Injury Assaults Insurance Coverage Product Liability Legal/ Medical Malpractice CREDIT AND CONSUMER LAW Collections/Debt Negotiations Mortgage Foreclosure Student Loans Bankruptcy Credit Discrimination Consumer Protection CRIMINAL LAW Advice Only Traffic & DWI Misdemeanor Felony Expungement of Court/Arrest Records DISCRIMINATION/CIVIL RIGHTS Gender Race Age Sexual Orientation Sexual Harassment Disability/Americans with Disabilities Act Privacy Issues ELDER LAW GOVERNMENT BENEFITS Overpayment/Fraud Denial of Benefits & Administrative Appeals Section 8 Housing Public Assistance (MFIP/Food Stamps/MSA/GA/MA) Disability (SSI) Disability (SSDI) IMMIGRATION LAW VAWA Self-Petition General Immigration Asylum REAL ESTATE LAW Landlord/tenant Expungement of Unlawful Detainer Residential Commercial Housing Discrimination TAX LAW Individual Tax Issues Business Tax Issues TESTAMENTARY ISSUES Simple Wills Estate Planning Probate Mental Health Commitment Guardianship/Conservatorship Power of Attorney Health Care Directive OTHER 2

Unmarried Couples Spousal Maintenance Complex Marital Property/Debt Division Prenuptial Agreements Grandparent/Third Party Child Custody Post-divorce Matters & Modifications Family Law Appeals Family

3 Volunteer Opportunities 1. Self-Represented Legal Clinic Assist low-income clients acting pro se in family law matters by providing legal advice, helping prepare court papers, and preparing clients to represent themselves in upcoming proceedings. No court appearances. Tubman screens cases for financial eligibility, case priorities, and legal merit. First meeting is at a clinic, with follow-up at volunteer attorney s office if needed. Assisted by law student or paralegal. One client at each clinic. Monday 6:00-8:00 p.m. Thursday 6:00-8:00 p.m. Friday 10:00 - noon Would you like to: Mentor a less-experienced attorney Be mentored by a more-experienced attorney Maplewood (Tubman, 1725 Monastery Way the former St. Paul s Monastery) How often would you like to volunteer at SRLC? Monthly Every other month Other 2. Pro Bono Family Law Representation Represent low-income clients pro bono. Tubman screens cases for financial eligibility, case priorities, legal merit, and need for legal representation. Volunteer law students or paralegals available to assist. Would you like assistance from: Volunteer 2 nd or 3 rd year law student Volunteer paralegal Would you like to: Mentor a less-experienced attorney Be mentored by an experienced attorney 3. Pro Bono Safety Project Represent low-income victims of domestic violence in OFPs or HROs two or three times a year. Tubman provides training, screens cases and provides support. 4. Family Law Clinics (provide brief individual legal advice to up to 5 clients at a two-hour clinic) Monday 6:00-8:00 p.m. Thursday 6:00-8:00 p.m. Friday 9:30-11:30 a.m. St Paul Midway Area (Seton Services/Catholic Charities, 1276 University Ave W) St. Louis Park (Perspectives, Inc., 3381 Gorham Ave) Bloomington (Cornerstone, 1000 E.80 th St) Maplewood (Tubman, 1725 Monastery Way the former St. Paul s Monastery) Family Law Clinic in Spanish * Please list day(s) of week that works for you (times are as listed above) How often would you like to volunteer at law clinics? Once a month Every Other Month Other 3

upcoming proceedings. No court appearances. Tubman screens cases for financial eligibility, case priorities, and legal merit.

4 Attorney Agreement Tubman Mission I understand that Tubman s Vision is: Safe and healthy individuals, families, and communities. Our Mission is: Promoting safe and healthy individuals, families, and communities through evidence-based intervention, prevention, and education. I agree to provide services to Tubman clients in accordance with that mission and in a respectful, empowering manner. Licensing and Legal Ethics I am currently authorized to practice law in Minnesota and in other states indicated on the first page of the attorney application. I have not been publicly disciplined by the Minnesota Supreme Court or the Lawyers Board of Professional Responsibility or similar boards in other states, except as follows: Attorney Registration Number (Minnesota Supreme Court) I have the legal knowledge, skill, thoroughness and preparation reasonably necessary to represent clients (in accordance with Rule 1.1 of the Minnesota Rules of Professional Conduct) in the areas I have indicated on the volunteer and referral information sheet. Tubman Materials I acknowledge that outlines, handouts, brochures and other materials developed by Tubman staff in connection with Tubman legal information sessions, Law Clinic, Self-Represented Legal Clinic, and other services are the property of Tubman. I agree that I will not use those materials (or substantially similar materials) except in connection with Tubman services. Services of Volunteer Attorneys I will honor my volunteer commitments by providing services when scheduled, except in emergencies. I will give the Legal Services staff a minimum of 48 hours notice of cancellation when schedule changes are necessary. It is my responsibility to keep the Legal Services staff informed of any problems with my volunteer commitment or duties. I understand that A commitment to low-income clients receiving fair and competent legal representation is a prerequisite for participation in the Legal Services Program. I have such a commitment. I may not represent clients seen in the Law Clinic unless I take their case pro bono. I cannot solicit clients from the Law Clinic setting. Services of Referral Attorneys I do not wish to receive referrals. As a referral attorney with Tubman Legal Services, I will provide legal representation to clients referred to me by Tubman and will commit to reduce my fee, offer a discount, use a sliding fee scale, or use other means to make legal services accessible to women. I currently expect to do that as follows: Hourly Rate Retainer Hourly rate for Tubman low income clients Retainer for Tubman low income clients Sliding Fee Scale Payment Plan Accept Credit Cards? Use other means? 4

I agree to provide services to Tubman clients in accordance with that mission and in a respectful, empowering manner.

5 Because we understand that many attorneys work out different fee arrangements with clients based on individual client circumstances and the attorney s pro bono and reduced-fee caseload, the above information is for use by Legal Services staff and is not provided to clients. References Please provide two professional references whom we can contact about your competence, reliability, and ethics. 1. Name Phone ( ) 2. Name Phone ( ) Signature Date Revised Jan/2013 5

Atlanta Bar Association LAWYER REFERRAL & INFORMATION SERVICE 229 Peachtree Street, Suite 400 Atlanta, Georgia 30303

Atlanta Bar Association LAWYER REFERRAL & INFORMATION SERVICE 229 Peachtree Street, Suite 400 Atlanta, Georgia 30303 Please complete all information on the application, including the waiver. Should you