Attorneys Application for Funding

First Name

Last Name

Phone

Website

Address Line 1

Address Line 2

City

State

Zip Code

Bar Number

State(s) of Admission

Basic Facts of Case

Charges

Is your client currently incarcerated:

YesNo

Has bail been set and in what amount?

Are you assigned counsel?

YesNo

Have you been retained as private counsel?

YesNo

What is your retainer amount and attorney fee scale?

Does your office have access to social workers, case managers or counselors?

Are you looking for funding for [Check all that apply]

Expert Witness(es)Attorney Fees

Expert Witness(es). Please tell us about the type of expert and why they're necessary, their rates, contact info and professional/education background.

Attorney Fees. Please share a list of case expenses.

What collateral issues is your client struggling with? [E.g. housing, childcare]

Do you have any additional questions, comments, or information for us?

Contact Information