Part I: Volunteer Information:
City: _______________________ State: _________________ Zip: _________________________
Phone: ____________________________ E-mail: ______________________________________
Chose those that apply:
I am a member of the State Bar of California and have no disciplinary actions against me.
Bar # ___________________ Practice Areas: __________________________________
I am a CFP® and have no disciplinary actions against me. CFP® # ____________________
I am a CPA and have no disciplinary actions against me. CPA # _____________________
I am not an attorney, CFP®, or CPA. My professional status or occupation is: ________________________________________________________________________
Other than English, I speak the following languages. _____________________________
Part II: Criminal Background:
Have you ever been investigated or convicted of committing a misdemeanor or felony?
YES NO (Please Circle). If yes, please explain ______________________________________________ __________________________________________________________________________________________________________________________________________________________________________
Part III: Conditions of Volunteer Participation:
I understand and agree that my services will be rendered free of any charge to referred clients, unless otherwise agreed to by the board of the Professional Alliance for Children. I agree to hold all client and case matters in the strictest confidence and shall adhere to all policies which serve to protect the attorney-client relationship. Working with other volunteer professionals, as permitted by the Professional Rules of Conduct and other applicable law, is encouraged.
Signature: ______________________________ Date: __________________________