APPLICATION for LEGAL ASSISTANCE (Individual)

APPLICATION FOR LEGAL ASSISTANCE (Individual)

Application Fee*: $55.00

Rush Request Fee**: $55.00

Please fill in both sides of this application as completely as possible and return it with a non-refundable application processing fee of $55 made payable to:

Arts & Business Council of Greater Boston

c/o Volunteer Lawyers for the Arts of Massachusetts

15 Channel Center Street - Suite 103

Boston, MA 02210

......

Today’s Date:

Name :

Address:

(City)(State)(Zip Code)

Daytime Phone: ( ) Evening Phone: ( )

Email address:

PART I - GENERAL INFORMATION

1. Briefly describe your primary artistic activities (dancer, graphic artist, filmmaker, etc.):

2.a. Please give a brief description of your arts-related legal problem/question. Only one (1) legal problem / issue per application.

If necessary, you may attach an additional sheet to complete this section. Please be as detailed as necessary while excluding details which you believe should be kept confidential until you are interviewed by an assigned attorney:

2.b Please list any individuals or legal entities (including addresses) involved in the matter, if any.

3. Have you consulted an attorney concerning the above matter? If so, please explain who was contacted, the advice given and why you are not pursuing the matter with the attorney consulted:

4. How did you hear about VLA?

5. May we use information on this application for fundraising purposes? Yes ____ No

6. I would like to apply for Pro Bono services: Y or N (If yes, Part II is required)

7. Would you like to be a part of our mailing list and receive information on upcoming webinars, seminars, or events? Y or N

* The Application fee is a non-refundable fee to process the application and does not guarantee an attorney. Applications are typically processed within one to two weeks of submittal.

** The Rush Request fee is a non-refundable fee to expedite the application due to a pending deadline does not guarantee an attorney. Rush request application are typically processed within 48 hours of submittal.

Completion of Part II is required if you wish to be considered for free (pro-bono) legal services.

PART II - FINANCIAL INFORMATION

Filmmakers should provide a separate projected budget analysis including plans for the procurement of funds.

1. What is your household or family gross taxable annual income based on last year's tax return (line 37 on form 1040)? ______

2. How many dependents are in your household?______

3. Do you have any special needs, such as:

_____ Child care _____ Child support or alimony

_____ Required educational expenses

_____ Special employment expenses _____ Other: ______

4. Please list the value of the following:

Value of Money Market or Savings Account: ______

Own Rental Property: Y or N

5. Please enclose the first few pages of your most recent tax return showing your adjusted gross income (AGI). Include Schedule C of Form 2106. If you do not have a tax return, please include a copy of your latest bank statement account, along with your latest W-2s and 1099s. PLEASE DELETE YOUR SOCIAL SECURITY NUMBER FROM THESE DOCUMENTS.

6. State your income to date for the current year. Please include employment income, unemployment compensation, social security, grants and fellowships, performance fees, sales of artwork, rental income, worker's compensation, alimony, and any other income received. ______

7. If I do not qualify for pro bono (free) legal assistance, I DO / DO NOT (circle one) want a VLA referral.

PART III - OPTIONAL

For statistical purposes only, some of our funding sources require the following information:

Age:Under 18 ____Race:White (not Hispanic) ____

18-34 ____Hispanic ____

35-59 ____Black ____

60 and over ____American Indian ____

Asian ____

Other ____

PART IV - CERTIFICATION

I hereby affirm that the information contained in this application, or attached to it, is correct, and to the best of my knowledge, complete. This questionnaire fully and accurately describes the problem for which this organization is requesting legal assistance. I understand that (1) the VLA cannot guarantee that it will be able to refer my case to a volunteer attorney; (2) the VLA will not be responsible for the outcome of any referral which it makes; (3) I am free to select or not select any attorney to whom I am referred; (4) any attorney to whom I may be referred is free to accept or not accept the referral; (5) the VLA does not make any representations or guarantees about the quality of legal assistance which any attorneys to which I may be referred may provide; (6) I will be represented by the referred lawyer, not the VLA; and (7) I agree to promptly notify VLA if I no longer need the assistance of a volunteer. (8) I have read and understand the VLA’s terms and conditions (attached).

SignatureDate

Volunteer Lawyers for the Arts

Client Legal Services Terms and Conditions

PLEASE READ CAREFULLY

1. Legal assistance from the Volunteer Lawyers for the Arts (VLA) is free to individual artists who have been approved based on financial information provided to the VLA on the application. If your income increases so that you no longer qualify for free legal services, you agree to notify VLA immediately. Any client who misrepresents his financial circumstances will be responsible for the full amount of legal fees incurred and may be required to reimburse VLA for related expenses. By signing this application you acknowledge and represent that you have provided the VLA with accurate financial information and understand that you will be held liable for any fees incurred by your volunteer lawyer should you misrepresent your financial circumstances.
2. Any information obtained by VLA in the process of working with you, including client communication, information and materials, is treated as confidential unless you direct us otherwise. While VLA strives to create learning opportunities and an open office environment, we are committed to protecting your privacy and require all persons with access to confidential information to sign a Pledge of Confidentiality. These persons could include volunteers, interns and/or other employees of the Arts & Business Council. Please let us know if you have any questions or concerns about the confidentiality of your information.
3. If, after your initial consultation with VLA, you need further legal assistance, your case may be referred to a volunteer lawyer. Placement with a volunteer lawyer typically takes between two to three weeks. We make our best effort to find a volunteer lawyer for every qualified and eligible applicant, but cannot guarantee that one will agree to help you.
4. VLA will notify you by email when we locate a volunteer lawyer who has agreed to provide you with pro bono assistance. We will advise you of his/her phone number at the time. As this is our primary method of contact, please notify us of any change in your phone number or email address immediately. IT IS YOUR RESPONSIBILITY TO CALL YOUR VOLUNTEER LAWYER PROMPTLY.
5. If at any point you no longer need the assistance of your volunteer lawyer or you have any problem or difficulty with your case or your volunteer, please contact VLA immediately.
6. Although you will not pay for your volunteer lawyer’s time, YOU ARE RESPONSIBLE FOR ANY OUT-OF-POCKET EXPENSES including filing fees, long-distance phone calls, charges for copying, messengers, etc. that may be required in relation to your case. It is your responsibility to discuss potential expenses with your volunteer lawyer.
7. YOUR VOLUNTEER LAWYER IS NOT YOUR GENERAL COUNSEL. He/she is your lawyer only for the specific matter assigned. If you require assistance with a different legal problem, you must return to VLA for reassignment. If you return to the original lawyer with new questions or legal problems without contacting VLA, that lawyer is then free to charge you for any help he/she chooses to provide. Please notify VLA if you choose to become a paying client of your volunteer lawyer for any additional matters.
8. PLEASE REMEMBER THAT YOUR VOLUNTEER LAWYER IS GENEROUSLY DONATING HIS OR HER TIME. IT IS IMPERATIVE THAT YOU BE PREPARED BEFORE CALLING YOUR LAWYER AND RESPOND TO HIM OR HER PROMPTLY. ALWAYS BE COURTEOUS AND RESPECTFUL OF HIS OR HER SCHEDULE!