Government Employees Pro Bono Application
First Name
*
Middle Initial
Last Name
*
Street Address
*
Street Address 2
City
*
State
*
Please Select
Alabama
Alaska
Arizona
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Delaware
District of Columbia
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Maryland
Massachusetts
Michigan
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New Hampshire
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New Mexico
New York
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Ohio
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Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Agency Name
*
Household Income
*
enter amount with no symbols
Number of People in Household
*
enter amount with no symbols
Military Service?
*
Yes
No
Case Information
Do you have now, or have had, the assistance of counsel with respect to this matter?
*
Yes
No
MSPB Appeal?
*
Yes
No
Date of MSPB Appeal
-
Month
-
Day
Year
Date
Docket number of the MSPB appeal
e.g. DC-0752-11-9999-I-1
MSPB Initial Decision?
*
Yes
No
Date of MSPB Initial Decision
-
Month
-
Day
Year
Date
Final Order from MSPB?
*
Yes
No
Date of Final Order
-
Month
-
Day
Year
Date
Briefly tell us about your case such as what you are appealing and why you are appealing it:
*
maximum 1000 characters
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