cooperating attorney form

NCLR receives thousands of phone calls and emails each year from individuals seeking assistance on legal issues related to sexual orientation and gender identity. We help direct these individuals to an LGBT-friendly attorney in their area who practices in the relevant field of law. If you would like to be listed as one of our cooperating attorneys, please complete the following form.

Basic Information

Items marked with an asterisk (*) are required.

Name:

Name First Required	Name Last Required

Street 1:

Street 2:

City/State/ZIP:

City	State	ZIP

Phone Number:

Email:

Firm name:

Remember me.

Please list the State and Bar number for each jurisdiction in which you are a member in good standing and licensed to practice.

State:

Bar #:

State:

Bar #:

Practice Areas

Check all that apply

Family Law

	adoption (individual)
	adoption (second/step-parent)
	alternative insemination
	custody/vis. (different sex)
	custody/vis. (same sex)
	dissolution/divorce (different sex)
	domestic violence
	estate planning
	guardianship
	mediation
	property/asset division
	probate
	surrogacy

Employment

	employment benefits (individual)
	employment discrimination

Elder Law

elder law issues

Immigration

	asylum
	other immigration issues

Transgender

	family law
	employment discrimination
	other

If other:

Youth

	school discrimination
	foster care/juvenile justice
	other

If other:

Aids/HIV

	benefits
	employment discrimination
	housing discrimination
	family law issues

Civil Rights

	civil liberties/1st amendment
	disability rights
	health care law
	housing
	prisoner's rights
	public accomodations

Criminal Law

criminal law

Other Categories

	bankruptcy
	commercial contracts
	mediation
	personal injury/torts
	public benefits
	tax
	other:

If other:

Cooperating Attorney - Optional

Are you willing to consider cases on any of the following bases:

	sliding-fee scale
	future participation with NCLR as co-counsel
	pro-bono representation

Yes, I'd like to participate in the Family Protection Project. With NCLR's assistance, I would be able to represent a low-income client pro bono or for a reduced fee.

Would you like to receive NCLR updates about cases and other legal issues?

Yes

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870 Market Street, Suite 370
San Francisco, CA 94102
Phone: 415.392.6257 | Fax: 415.392.8442