Application for Assistance (Organization)

Name:*


Contact Person for this Application:


Title:


Address:*


City:*


State:*


Zip:*


Home Phone:*


Business Phone:


Email:*




Do you own stocks and/or bonds?:
YesNo

Value:
$

Is this application for an existing organization?
YesNo

If yes, how long?


Is the organization incorporated?
If yes, in what state?


Tax Exemption Number:




Please indicate the type of organization by checking the appropriate category:

Arts Service OrganizationCommunity Arts CenterDanceDrama/TheaterInterdisciplinary Arts OrganizationMedia: Film/TV/Video/RadioMuseumMusicVisual: Crafts/Gallery/StudioOther (Please specify)

*You will be asked to provide your organization’s current annual budget, and/or financial statement, and Form 990.



Please answer the following questions:

1. Describe the nature of your art work and/or artistic activities.

2. Please explain in detail the nature of the problem for which you need legal assistance.

3. Have you consulted a lawyer concerning the above problem? If so, please provide the name and telephone number of that lawyer.

4. Are you currently represented by another lawyer? If so, please provide the name and telephone number of that lawyer.

5. How did you learn about MdVLA?

MdVLA’s funding sources may ask for names of some of our clients. If it is determined that
you are eligible for assistance, may we list your name? (Determination of your eligibility is in
no way affected by your response to this question.)
YesNo

I hereby affirm that the information contained in this application is correct and to the best of my knowledge, complete. I request that MdVLA refer me to a panel attorney. I agree to report immediately to MdVLA any changes in my circumstances that may affect my eligibility.

I understand that MdVLA makes no representation as to the skill of the referred lawyer nor as to a degree of successful representation.

I understand I will be represented by the referred lawyer or the referred lawyer’s law firm and not MdVLA. MdVLA is only a legal referral organization.

I agree to pay MdVLA a non-refundable administrative fee of $300 for 501(c)(3) nonprofit incorporation or $100 for other matters in the form of cash, check or money order payable to Maryland Volunteer Lawyers for the Arts.

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