ANGELS FOR WARRIORS

631-651-5471

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Home
About Us
Services
Registration
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Contact

Attorney Registration

Pro Bono Attorney Registration

If you wish to volunteer for the pro bono or the attorney reduced fee initiative, kindly complete the following application. Please note this is a secure site. Fields marked with (*) are required fields.

Date*:

Contact Information

First Name*:

Last Name:

Address*:

City*:

State*:

Country*:

Zip*:

Phone:

SSN or Last 4*:

Email*:

Emergency Contact First Name*:

Emergency Contact Last Name:

Emergency Contact Phone:

Marital Status*:

Single

Single/Engaged

Married

Divorced

Widowed

Separated

Gender*:

Male

Female

Date Of Birth*:

Spouse Name*:

Number of Dependents/Ages*:

Service Information

Branch of Service*:

Pay Grade*:

Dates of Service*:

Type of Discharge*:

DOD Disability Rating(if applicable)*:

Have you been determined to be Disabled under Social Security?

Yes

No

Have you applied for Social Security Income or Disability?

Yes

No

VA Disability Ranking*:

Have you applied for VA benefits?

Yes

No

Do you have a pending VA Claim or claim on appeal?

Yes

No

If yes, please explain:

Do you have a denial letter?

Yes

No

VA/Estimated Disability Rating*:

Upload a copy of your DD-214 form:

Upload photo ID:

Other Information

Are you currently employed?

Yes

No

Employer Information*:

Estimated annual income*:

To qualify for pro bono legal assistance, your income, based on W-2s provided, must comply with the Federal Income Guidelines for poverty.

Are you currently working with an attorney?

Yes

No

Attorney Name:

Attorney Phone Number :

Type of Assistance Needed IE: Legal/Other (Please note: With the exception of traffic violations, we do not handle criminal matters):

Detailed Explanation of Assistance needed/Comments:

May we share your information in order to assist you?

Yes

No

Do you give us permission to discuss your case with other Agencies/Attorneys?
Veterans’ Administration:

Yes

No

Other Agencies or Attorneys:

Yes

No

Name of VA Caseworker (if applicable):

Injuries (please list and explain):

How were you referred*?

How did you learn about Angels for Warriors?

Please explain:

I am NOT in need of legal assistance

I am in need of legal assistance. I will provide proof of income. *To qualify for pro bono legal assistance, your income, based on W-2s provided, must comply with the Federal Income Guidelines for poverty.

*Please scan and email or fax a copy of your DD-214 form and photo ID to [email protected] or 631-651-5473. Your registration is NOT complete without this form.

Angels For Warriors is a 501 (c)(3) not-for-profit organization that guides Long Island Nassau and Suffolk County Veterans, active duty military, and their families through the essential resources, with an emphasis on pro-bono and low-bono legal representation.

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July 14, 2022

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Contact Info

631-651-5471
631-651-5473
164 Main Street, Huntington, NY 11743

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