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UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF NEW YORK PRO BONO PANEL APPLICATION

Name (Last) Name of Firm Business Address E-mail Are you fluent in one or more foreign languages? If yes, please specify:

First

Middle

City

State Telephone (area code and number) *Yes No

Zip Code

DATE OF EDNY ADMISSION

/

/

OTHER ADMISSION(S): yy

mm dd

TYPE OF CASE(S) YOU WOULD PREFER TO REVIEW

Civil rights Social Security

Employment Discrimination No preference

COMMENTS REGARDING QUALIFICATIONS OR AVAILABILITY:

Applicant's Signature

Date

Pro Bono Panel Application - U.S. District Court-EDNY Rev. 2/2003