To qualify for pro bono legal assistance a business owner or entrepreneur must: (1) Reside in the county Los Angeles or operate a business in Los Angeles County; (2) Have an individual household income and assets that fall between 300% - 500% of the Federal Poverty Guidelines (FPG), OR less than $50,000 in liquid assets, AND (3) Own a business that has a qualifying community impact. Examples of a qualifying community impact are: businesses that promote community development, are minority, women, or veteran-owned, or are owned by a disabled individual, are located in high-poverty areas and meets the needs of an under-served community, or offers job training opportunities by employing local low-income residents.
PART I - PERSONAL INFORMATION Name *
Phone * Additional Contact Phone Number Address
* Owner's Race/Ethnicity Owner's Gender PART II - BUSINESS INFORMATION Name of Business * Business Website
* General Description of Business * Public Benefit/Purpose * Corporate Structure of Business If other, please describe Names of Co-Owners Number of Employees (Full and Part-Time) Approximate Value of Business Assets Approximate Business Gross Revenues Last Year PART III - PRIOR ASSISTANCE AND/OR LEGAL REPRESENTATION
Are you already working with another organization that helps small businesses? If so, please provide:
Name of Organization Name of Business Counselor or other Staff Phone Number of Business Counselor or other Staff Email of Business Counselor or other Staff
Have you already consulted another attorney or legal organization for legal assistance? If so, please provide: Name of contact or legal counsel Name of organization or law firm E-mail address of contact or legal counsel
Phone number of contact or legal counsel Brief description of legal issue/services provided PART IV – CURRENT LEGAL ISSUES FACED BY CLIENT Type of Legal Issue(s)
(please check all that apply) If other, Please describe Please upload any relevant documents in PDF or JPEG form Adverse Parties
Please list all other people, organizations, or companies that may be involved in your legal matter(s). For example, if you need help with a commercial lease, please provide the name of the landlord.
PART V – INFORMATION CONCERNING ELIGIBILITY FOR PRO BONO LEGAL ASSISTANCE How many people live in your household? What was the total income from all members of your household in 2016? What is the current total income from all members of your household? Please list your sources of income, including employment, investments, and government benefits such as unemployment insurance, SSI, SSD, and public assistance: Do you have any dependents you support financially (e.g. children or other family members)? Yes No If yes, how many? Do you have other significant financial obligations (such as child care, educational expenses, child support or alimony) that would help us evaluate your application? Other factors that should be considered in determining your eligibility for pro bono (free) legal assistance:
Bet Tzedek may request additional information and documentation to determine eligibility for free legal services, including but not limited to tax returns and a business plan.
APPLICANT STATEMENT AND AUTHORIZATION
By clicking the submit button below, I acknowledge that I am applying to Bet Tzedek Legal Services for help finding pro bono legal (volunteer) assistance. I understand that Bet Tzedek itself cannot provide me with legal representation or advice, and that Bet Tzedek is collecting information from me and may discuss my case with me solely for the purposes of (1) determining my eligibility for pro bono legal assistance; (2) assessing whether, in Bet Tzedek's discretion, the legal matter(s) I present are appropriate for pro bono legal assistance; and (3) attempting to find pro bono legal assistance for me.
I also understand that:
· Bet Tzedek may not be able to find pro bono legal assistance for me, and there is no assurance that Bet Tzedek or the law firms participating in Bet Tzedek's Small Business Development Project will be able to advise or represent me.
· Bet Tzedek cannot respond to crises, and cannot guarantee the length of time it may take to find a volunteer attorney, or to determine that pro bono legal assistance is not available or that the legal matter(s) presented are not appropriate for pro bono legal assistance.
I further acknowledge that Bet Tzedek may share the information I provide in this application, including information I provide in my discussions with Bet Tzedek's staff and in any other documents or records I provide to Bet Tzedek, with law firm staff and/or with volunteer attorneys. Bet Tzedek will share this information solely for the purpose of enabling law firm staff and/or volunteer attorneys to consider whether to represent me pro bono.
While legal assistance provided to me by Bet Tzedek and Bet Tzedek’s volunteers and partner organizations is free, I am responsible for other expenses related to this matter, which may include, but are not limited to, fees associated with government or regulatory filings, costs related to government publication requirements, and charges for services provided by third-party service providers.
I am providing an Intake Form to support my application. I understand that Bet Tzedek, volunteer attorneys, and law firms participating in Bet Tzedek's Small Business Development Project are relying on the accuracy of the Intake Form and all of the information I provide. I affirm that all of the information I am providing in the Intake Form is true and correct.