Getting Legal Benefits info to impacted residents First Name Last Name * Email (Main) * Cell Phone Alternate Phone Where are you located? - select - Bronx Brooklyn Manhattan Queens Staten Island Nassau Suffolk New Jersey Please list them here: Are you fluent in any languages besides English? Yes No (clear) If yes, please list them here: Are you a: - select - Lawyer Law Student Legal Worker Other If Other, please indicate: Are you affiliated with any organizations? If you are a law student, what school are you attending? Have you participated in any training on post-Sandy legal issues? Yes No (clear) If yes, what issues were covered? Have you provided any post-Sandy legal assistance thus far? Yes No (clear) If yes, please briefly describe: What type of law do you have experience in? Housing Immigration Insurance Employment Contract Criminal Public Benefits Other If Other, please indicate: Are you interested in helping staff legal clinics for those impacted by Sandy? Yes No (clear) If Yes, are you available: - select - One time only Ongoing Basis Are you interested and available to take on case work (through Occupy Sandy or a partner-referral organization) on a longer-term basis? Yes No (clear) Please be aware that all legal work is being provided without any charge to impacted individuals. By accepting case work you are agreeing to do so without requiring payment for any and all aspects of your work, regardless of duration or complexity. * - select - Agree Don’t Agree Occupy Sandy cannot provide malpractice insurance Supervision is unavailable for any accepted casework. Collaboration & consultation is encouraged. Please do not accept cases involving matters for which you do not have requisite skill/level of expertise. - select - Agree Don’t Agree May we share your information with partner groups so we can match you with projects and case work in your indicated area of interest? Yes No (clear) Are you interested in working on advocacy, impact litigation, and/or systemic-change-motivated work? Yes No (clear) If Yes, in which of the following areas are you interested? Housing Health Environmental Impact Other If Other, please indicate: Would you be willing to help conduct legal research? Yes No (clear) Would you be willing to help with data entry/info management? Yes No (clear) Are you interested in providing legal support to community development projects? Yes No (clear) If Yes, in which area would you be interested in supporting? Project negotiations Contracts Organizational development (i.e. fiscal sponsorship, receiving tax-free status) Zoning law and community development Safety & liability issues Other If other, please indicate: Is there any more information you would like to provide (such as connections you may have with legal organizations, suggestions about legal issues to check-in on, etc.)
